Training in transesophageal echocardiography is also vital. This is strongly recommended for cyanotic patients, patients with pulmonary hypertension, or with some rhythm abnormalities. Pregnant women with CHD should be managed by the patient's obstetrician and ACHD cardiologists together with a cardiac anesthetist if necessary. Regular dental care often in a hospital setting is mandatory for adult patients with CHD to decrease the likelihood of caries, abscesses or periodontal disease, all of which contribute to increased incidence of infective endocarditis. There is justification for government subsidization of dental care in those patients unable to afford it.
Endocarditis prophylaxis is recommended except for 'fillings above the gum line'.
Despite its lifelong presence most adolescents and young adults with CHD have inadequate knowledge about their cardiac conditions. Health care providers must assess each patient's knowledge of his or her condition and give appropriate information to enable independent decision-making about choices in care. Adults with CHD should be encouraged to understand not only their disease, but the medications they use. They should be involved in major management decisions or decisions involving invasive procedures. Further involvement of patients in evaluation of processes, programs, and in the planning of research trials within the constraints of their motivation and capacity to understand them is ideal.