Author: Vivien T. Thomas
Publisher: University of Pennsylvania Press
ISBN: 9780812216349
Category : Biography & Autobiography
Languages : en
Pages : 268
Book Description
Visitors to the Blalock Building at the Johns Hopkins University Medical Center are greeted by portraits of two great men. One, of renowned heart surgeon Alfred Blalock, speaks for itself. The other, of highschool graduate Vivien Thomas, is testimony to the incredible genius and determination of the first black man to hold a professional position at one of America's premier medical institutions. Thomas's dreams of attending medical school were dashed when the Depression hit. After spending some time as a carpenter's apprentice, Thomas took what he expected to be a temporary job as a technician in Blalock's lab. The two men soon became partners and together invented the field of cardiac surgery. Partners of the Heart is Thomas's extraordinary autobiography. Trained in laboratory techniques by Alfred Blalock and Joseph W. Beard, Thomas remained Blalock's principal technician and laboratory chief for the rest of Blalock's distinguished career. Thomas very rapidly learned to perform surgery, to do chemical determinations, and to carry out physiologic studies. He became a phenomenal technician and was able to carry out complicated experimental cardiac operations totally unassisted and to devise new ones. In addition to telling Thomas's life story, Partners of the Heart traces the beginnings of modern cardiac surgery, crucial investigations into the nature of shock, and Blalock's methods of training surgeons.
Partners of the Heart
Author: Vivien T. Thomas
Publisher: University of Pennsylvania Press
ISBN: 9780812216349
Category : Biography & Autobiography
Languages : en
Pages : 268
Book Description
Visitors to the Blalock Building at the Johns Hopkins University Medical Center are greeted by portraits of two great men. One, of renowned heart surgeon Alfred Blalock, speaks for itself. The other, of highschool graduate Vivien Thomas, is testimony to the incredible genius and determination of the first black man to hold a professional position at one of America's premier medical institutions. Thomas's dreams of attending medical school were dashed when the Depression hit. After spending some time as a carpenter's apprentice, Thomas took what he expected to be a temporary job as a technician in Blalock's lab. The two men soon became partners and together invented the field of cardiac surgery. Partners of the Heart is Thomas's extraordinary autobiography. Trained in laboratory techniques by Alfred Blalock and Joseph W. Beard, Thomas remained Blalock's principal technician and laboratory chief for the rest of Blalock's distinguished career. Thomas very rapidly learned to perform surgery, to do chemical determinations, and to carry out physiologic studies. He became a phenomenal technician and was able to carry out complicated experimental cardiac operations totally unassisted and to devise new ones. In addition to telling Thomas's life story, Partners of the Heart traces the beginnings of modern cardiac surgery, crucial investigations into the nature of shock, and Blalock's methods of training surgeons.
Publisher: University of Pennsylvania Press
ISBN: 9780812216349
Category : Biography & Autobiography
Languages : en
Pages : 268
Book Description
Visitors to the Blalock Building at the Johns Hopkins University Medical Center are greeted by portraits of two great men. One, of renowned heart surgeon Alfred Blalock, speaks for itself. The other, of highschool graduate Vivien Thomas, is testimony to the incredible genius and determination of the first black man to hold a professional position at one of America's premier medical institutions. Thomas's dreams of attending medical school were dashed when the Depression hit. After spending some time as a carpenter's apprentice, Thomas took what he expected to be a temporary job as a technician in Blalock's lab. The two men soon became partners and together invented the field of cardiac surgery. Partners of the Heart is Thomas's extraordinary autobiography. Trained in laboratory techniques by Alfred Blalock and Joseph W. Beard, Thomas remained Blalock's principal technician and laboratory chief for the rest of Blalock's distinguished career. Thomas very rapidly learned to perform surgery, to do chemical determinations, and to carry out physiologic studies. He became a phenomenal technician and was able to carry out complicated experimental cardiac operations totally unassisted and to devise new ones. In addition to telling Thomas's life story, Partners of the Heart traces the beginnings of modern cardiac surgery, crucial investigations into the nature of shock, and Blalock's methods of training surgeons.
Mending a Shattered Heart
Author: Stefanie Ph.D. Carnes
Publisher: eBookIt.com
ISBN: 0983271356
Category : Family & Relationships
Languages : en
Pages : 244
Book Description
When your partner betrays, what are the first steps to picking up the pieces of your shattered heart? Many unsuspecting people wake up every day to discover their loved one, the one person whom they are supposed to trust completely, has been living a life of lies and deceit because they suffer from a disease-sex addiction. This is a disease shrouded in secrecy and shame. This is your go-to-guide for what to do when you discover your partner is a sex addict. Each chapter is based on frequently asked questions by partners such as: Should I Stay or Should I Go? Is This Going to Get Better? How Do I Set Boundaries and Keep Myself Safe? and What Should I Tell the Kids?
Publisher: eBookIt.com
ISBN: 0983271356
Category : Family & Relationships
Languages : en
Pages : 244
Book Description
When your partner betrays, what are the first steps to picking up the pieces of your shattered heart? Many unsuspecting people wake up every day to discover their loved one, the one person whom they are supposed to trust completely, has been living a life of lies and deceit because they suffer from a disease-sex addiction. This is a disease shrouded in secrecy and shame. This is your go-to-guide for what to do when you discover your partner is a sex addict. Each chapter is based on frequently asked questions by partners such as: Should I Stay or Should I Go? Is This Going to Get Better? How Do I Set Boundaries and Keep Myself Safe? and What Should I Tell the Kids?
Pioneering Research in Surgical Shock and Cardiovascular Surgery
Author: Vivien T. Thomas
Publisher:
ISBN:
Category : Biography & Autobiography
Languages : en
Pages : 280
Book Description
Vivien T. Thomas, a high school graduate, was awarded an honorary doctorate by the Johns Hopkins University and was made a member of the medical school faculty in recognition of his contributions to the practice of cardiovascular surgery and to the education of young surgeons. Pioneering Research in Surgical Shock and Cardiovascular Surgery is the autobiography of this extraordinary black man who struggled against overwhelming odds and achieved international recognition in a highly sophisticated field in which he had no formal education or certification.
Publisher:
ISBN:
Category : Biography & Autobiography
Languages : en
Pages : 280
Book Description
Vivien T. Thomas, a high school graduate, was awarded an honorary doctorate by the Johns Hopkins University and was made a member of the medical school faculty in recognition of his contributions to the practice of cardiovascular surgery and to the education of young surgeons. Pioneering Research in Surgical Shock and Cardiovascular Surgery is the autobiography of this extraordinary black man who struggled against overwhelming odds and achieved international recognition in a highly sophisticated field in which he had no formal education or certification.
A Chat with Vivien Thomas
Author: Jessie B. Gladden
Publisher: iUniverse
ISBN: 1532085869
Category : Biography & Autobiography
Languages : en
Pages : 79
Book Description
“ Experiece the interview with Mr Thomas himself as though you were there the history making development of the Blue Baby Operation.
Publisher: iUniverse
ISBN: 1532085869
Category : Biography & Autobiography
Languages : en
Pages : 79
Book Description
“ Experiece the interview with Mr Thomas himself as though you were there the history making development of the Blue Baby Operation.
Partner to the Poor
Author: Paul Farmer
Publisher: Univ of California Press
ISBN: 0520257111
Category : Biography & Autobiography
Languages : en
Pages : 678
Book Description
"Dr. Paul Farmer is one of the most extraordinary people I've ever known. Partner to the Poor recounts his relentless efforts to eradicate disease, humanize health care, alleviate poverty, and increase opportunity and empowerment in the developing world. It will inspire us all to do our parts."--William J. Clinton "If the world is curious about Paul Farmer, there is a reason for that. No one has done more than he has in bringing modern medicine to the poor across the globe and no one has exceeded him in making us appreciate the diverse barriers that prevent proper medicine from reaching the underdogs of the world. In this wonderful collection of essays, putting together Paul Farmer's writings over more than two decades, we can see how his far-reaching ideas have developed and radically enhanced the understanding of the challenges faced by healthcare in the uneven world in which we live. This is an altogether outstanding book."--Amartya Sen, Nobel Laureate, Economics "To delve into these pages is to join one of the world's great explorers on an epic life journey--to grapple with culture, poverty, disease, health care, ethics, and ultimately our common humanity in the Age of AIDS. Paul Farmer is a pioneer, guide, and inspiration at a time of unprecedented contrasts: between wealth and poverty, power and powerlessness, health and disease, compassion and neglect. His medical expertise, anthropological vision, and unflinching decency have helped to recharge our world with moral purpose."--Jeffrey D. Sachs, Columbia University "Wow! Perfect for teaching. This is more than vintage Farmer. Editor Haun Saussy knows Farmer's work inside out and has assembled and organized 25 classic articles that project the heart of Farmer's brilliant, radical, inspiring, eminently practical and (dare I say) genuinely subversive work."--Philippe Bourgois, author of Righteous Dopefiend "If they gave Nobel Prizes for raising moral awareness, Paul Farmer would have won his a long time ago. For several decades now, his work has posed a challenge to anyone who dares say that radically improving the health of the world's poor can't be done. This splendid compilation of the best of his work allows us to follow a restless, creative, compassionate mind in action, in and out of prisons and barrios and mud huts and hospital wards, from Haiti to Rwanda to Moscow, never taking 'no' for an answer."--Adam Hochschild, author of Bury the Chains "Paul Farmer is a deep scholar of Haitian society, a formidable medical anthropologist, an implacable theorist of structural violence and health as a human right, and an ethicist for whom the place of social justice in medicine and in the world is an existential need. This book is the platform of interconnected intellectual, academic, and practical engagements upon which the amazing, world-transforming life of Farmer stands."--Arthur Kleinman, author of What Really Matters: Living a Moral Life amidst Uncertainty and Danger "This collection shows the impressive catalytic effects of original scholarship when combined with action, activism, and a commitment to social justice in health. Paul Farmer and his PIH colleagues have twice changed World Health Organization policies; they continue to have a lasting impact on the global health movement and on the lives of the poor.--Peter Brown, Emory University
Publisher: Univ of California Press
ISBN: 0520257111
Category : Biography & Autobiography
Languages : en
Pages : 678
Book Description
"Dr. Paul Farmer is one of the most extraordinary people I've ever known. Partner to the Poor recounts his relentless efforts to eradicate disease, humanize health care, alleviate poverty, and increase opportunity and empowerment in the developing world. It will inspire us all to do our parts."--William J. Clinton "If the world is curious about Paul Farmer, there is a reason for that. No one has done more than he has in bringing modern medicine to the poor across the globe and no one has exceeded him in making us appreciate the diverse barriers that prevent proper medicine from reaching the underdogs of the world. In this wonderful collection of essays, putting together Paul Farmer's writings over more than two decades, we can see how his far-reaching ideas have developed and radically enhanced the understanding of the challenges faced by healthcare in the uneven world in which we live. This is an altogether outstanding book."--Amartya Sen, Nobel Laureate, Economics "To delve into these pages is to join one of the world's great explorers on an epic life journey--to grapple with culture, poverty, disease, health care, ethics, and ultimately our common humanity in the Age of AIDS. Paul Farmer is a pioneer, guide, and inspiration at a time of unprecedented contrasts: between wealth and poverty, power and powerlessness, health and disease, compassion and neglect. His medical expertise, anthropological vision, and unflinching decency have helped to recharge our world with moral purpose."--Jeffrey D. Sachs, Columbia University "Wow! Perfect for teaching. This is more than vintage Farmer. Editor Haun Saussy knows Farmer's work inside out and has assembled and organized 25 classic articles that project the heart of Farmer's brilliant, radical, inspiring, eminently practical and (dare I say) genuinely subversive work."--Philippe Bourgois, author of Righteous Dopefiend "If they gave Nobel Prizes for raising moral awareness, Paul Farmer would have won his a long time ago. For several decades now, his work has posed a challenge to anyone who dares say that radically improving the health of the world's poor can't be done. This splendid compilation of the best of his work allows us to follow a restless, creative, compassionate mind in action, in and out of prisons and barrios and mud huts and hospital wards, from Haiti to Rwanda to Moscow, never taking 'no' for an answer."--Adam Hochschild, author of Bury the Chains "Paul Farmer is a deep scholar of Haitian society, a formidable medical anthropologist, an implacable theorist of structural violence and health as a human right, and an ethicist for whom the place of social justice in medicine and in the world is an existential need. This book is the platform of interconnected intellectual, academic, and practical engagements upon which the amazing, world-transforming life of Farmer stands."--Arthur Kleinman, author of What Really Matters: Living a Moral Life amidst Uncertainty and Danger "This collection shows the impressive catalytic effects of original scholarship when combined with action, activism, and a commitment to social justice in health. Paul Farmer and his PIH colleagues have twice changed World Health Organization policies; they continue to have a lasting impact on the global health movement and on the lives of the poor.--Peter Brown, Emory University
Facing Heartbreak
Author: Stefanie Carnes
Publisher:
ISBN: 9780983271338
Category : Psychology
Languages : en
Pages : 0
Book Description
The first workbook to help partners of sex addicts cope with discovering their loved one has compulsive sexual behaviors.
Publisher:
ISBN: 9780983271338
Category : Psychology
Languages : en
Pages : 0
Book Description
The first workbook to help partners of sex addicts cope with discovering their loved one has compulsive sexual behaviors.
Tiny Stitches
Author: Gwendolyn Hooks
Publisher: Lee & Low Books
ISBN: 9781620141564
Category : Juvenile Nonfiction
Languages : en
Pages : 0
Book Description
The life story of Vivien Thomas, an African American surgical technician who developed the first procedure used to perform open-heart surgery on children.
Publisher: Lee & Low Books
ISBN: 9781620141564
Category : Juvenile Nonfiction
Languages : en
Pages : 0
Book Description
The life story of Vivien Thomas, an African American surgical technician who developed the first procedure used to perform open-heart surgery on children.
Heart
Author: Dick Cheney
Publisher: Simon and Schuster
ISBN: 1476725411
Category : Biography & Autobiography
Languages : en
Pages : 391
Book Description
Former Vice President Dick Cheney and his longtime cardiologist, Dr. Jonathan Reiner, share the story of Cheney’s thirty-five-year battle with heart disease—providing insight into the incredible medical breakthroughs that have changed cardiac care over the last four decades. For as long as he has served at the highest levels of business and government, Vice President Dick Cheney has also been one of the world’s most prominent heart patients. Now, for the first time ever, Cheney, together with his longtime cardiologist, Jonathan Reiner, MD, shares the very personal story of his courageous thirty-five-year battle with heart disease, from his first heart attack in 1978 to the heart transplant he received in 2012. In 1978, when Cheney suffered his first heart attack, he received essentially the same treatment President Eisenhower had had in 1955. Since then, cardiac medicine has been revolutionized, and Cheney has benefitted from nearly every medical breakthrough. At each juncture, when Cheney faced a new health challenge, the technology was one step ahead of his disease. Cheney’s story is in many ways the story of the evolution of modern cardiac care. Heart is the riveting, singular memoir of both doctor and patient. Like no US politician has before him, Cheney opens up about his health struggles, sharing harrowing, never-before-told stories about the challenges he faced during a perilous time in our nation’s history. Dr. Reiner provides his perspective on Cheney’s case and also gives readers a fascinating glimpse into his own education as a doctor and the history of our understanding of the human heart. He masterfully chronicles the important discoveries, radical innovations, and cutting-edge science that have changed the face of medicine and saved countless lives. Powerfully braiding science with story and the personal with the political, Heart is a sweeping, inspiring, and ultimately optimistic book that will give hope to the millions of Americans affected by heart disease.
Publisher: Simon and Schuster
ISBN: 1476725411
Category : Biography & Autobiography
Languages : en
Pages : 391
Book Description
Former Vice President Dick Cheney and his longtime cardiologist, Dr. Jonathan Reiner, share the story of Cheney’s thirty-five-year battle with heart disease—providing insight into the incredible medical breakthroughs that have changed cardiac care over the last four decades. For as long as he has served at the highest levels of business and government, Vice President Dick Cheney has also been one of the world’s most prominent heart patients. Now, for the first time ever, Cheney, together with his longtime cardiologist, Jonathan Reiner, MD, shares the very personal story of his courageous thirty-five-year battle with heart disease, from his first heart attack in 1978 to the heart transplant he received in 2012. In 1978, when Cheney suffered his first heart attack, he received essentially the same treatment President Eisenhower had had in 1955. Since then, cardiac medicine has been revolutionized, and Cheney has benefitted from nearly every medical breakthrough. At each juncture, when Cheney faced a new health challenge, the technology was one step ahead of his disease. Cheney’s story is in many ways the story of the evolution of modern cardiac care. Heart is the riveting, singular memoir of both doctor and patient. Like no US politician has before him, Cheney opens up about his health struggles, sharing harrowing, never-before-told stories about the challenges he faced during a perilous time in our nation’s history. Dr. Reiner provides his perspective on Cheney’s case and also gives readers a fascinating glimpse into his own education as a doctor and the history of our understanding of the human heart. He masterfully chronicles the important discoveries, radical innovations, and cutting-edge science that have changed the face of medicine and saved countless lives. Powerfully braiding science with story and the personal with the political, Heart is a sweeping, inspiring, and ultimately optimistic book that will give hope to the millions of Americans affected by heart disease.
Heart Failure: A Companion to Braunwald's Heart Disease E-Book
Author: G. Michael Felker
Publisher: Elsevier Health Sciences
ISBN: 0323609880
Category : Medical
Languages : en
Pages : 937
Book Description
Up-to-date, authoritative and comprehensive, Heart Failure, 4th Edition, provides the clinically relevant information you need to effectively manage and treat patients with this complex cardiovascular problem. This fully revised companion to Braunwald's Heart Disease helps you make the most of new drug therapies such as angiotensin receptor neprilysin inhibitors (ARNIs), recently improved implantable devices, and innovative patient management strategies. Led by internationally recognized heart failure experts Dr. G. Michael Felker and Dr. Douglas Mann, this outstanding reference gives health care providers the knowledge to improve clinical outcomes in heart failure patients. - Focuses on a clinical approach to treating heart failure, resulting from a broad variety of cardiovascular problems. - Covers the most recent guidelines and protocols, including significant new updates to ACC, AHA, and HFSA guidelines. - Covers key topics such as biomarkers and precision medicine in heart failure and new data on angiotensin receptor neprilysin inhibitors (ARNIs). - Contains four new chapters: Natriuretic Peptides in Heart Failure; Amyloidosis as a Cause of Heart Failure; HIV and Heart Failure; and Neuromodulation in Heart Failure. - Covers the pathophysiological basis for the development and progression of heart failure. - Serves as a definitive resource to prepare for the ABIM's Heart Failure board exam. - 2016 British Medical Association Award: First Prize, Cardiology (3rd Edition).
Publisher: Elsevier Health Sciences
ISBN: 0323609880
Category : Medical
Languages : en
Pages : 937
Book Description
Up-to-date, authoritative and comprehensive, Heart Failure, 4th Edition, provides the clinically relevant information you need to effectively manage and treat patients with this complex cardiovascular problem. This fully revised companion to Braunwald's Heart Disease helps you make the most of new drug therapies such as angiotensin receptor neprilysin inhibitors (ARNIs), recently improved implantable devices, and innovative patient management strategies. Led by internationally recognized heart failure experts Dr. G. Michael Felker and Dr. Douglas Mann, this outstanding reference gives health care providers the knowledge to improve clinical outcomes in heart failure patients. - Focuses on a clinical approach to treating heart failure, resulting from a broad variety of cardiovascular problems. - Covers the most recent guidelines and protocols, including significant new updates to ACC, AHA, and HFSA guidelines. - Covers key topics such as biomarkers and precision medicine in heart failure and new data on angiotensin receptor neprilysin inhibitors (ARNIs). - Contains four new chapters: Natriuretic Peptides in Heart Failure; Amyloidosis as a Cause of Heart Failure; HIV and Heart Failure; and Neuromodulation in Heart Failure. - Covers the pathophysiological basis for the development and progression of heart failure. - Serves as a definitive resource to prepare for the ABIM's Heart Failure board exam. - 2016 British Medical Association Award: First Prize, Cardiology (3rd Edition).
Critical Heart Disease in Infants and Children E-Book
Author: Ross M. Ungerleider
Publisher: Elsevier Health Sciences
ISBN: 1455751006
Category : Medical
Languages : en
Pages : 1195
Book Description
**Selected for Doody's Core Titles® 2024 with "Essential Purchase" designation in Pediatric Surgery** Now in brilliant full color and reflecting recent significant changes in the field, Critical Heart Disease in Infants and Children, 3rd Edition, keeps you abreast of the skills and knowledge required to safely care for children with congenital and acquired heart disease in the ICU. Pediatric intensivists, cardiologists, cardiac surgeons, and anesthesiologists from leading centers around the world provide a well-rounded perspective on basic scientific principles, medical and pharmacologic treatments, surgical techniques, and equipment. - Features comprehensive updates throughout the text, including indications, techniques, potential complications in perioperative management of patients, and surgical techniques for congenital heart disease. - Covers recent advances in the treatment of pulmonary hypertension, developments in mechanical assist devices, heart and lung transplantation, and interventional cardiac catheterization. - Features an all-new, full-color format that speeds navigation and helps clarify complex concepts. - Contains 27 new chapters with an emphasis on the team approach to patient care in the ICU including creating multidisciplinary teams, quality and performance improvement, training , and challenges and solutions to developing a cohesive team environment. - Includes a detailed chapter on bedside ultrasound, walking you through the techniques you're most likely to encounter in the ICU. - Employs well-documented tables, text boxes, and algorithms to make clinical information easy to access, and more than two dozen video clips provide a more complete understanding of echocardiography, imaging modalities, pulmonary hypertension, and more. - Describes the basic pharmacology and clinical applications of new pharmacologic agents. - Examines issues affecting adults with congenital heart disease. - Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices. - Offers four completely new chapters: Cardiac Trauma, Congenital Heart Disease in the Adult, Congenitally Corrected Transposition of the Great Arteries, and Outcome Evaluation. - Describes the basic pharmacology and clinical applications of all of the new pharmacologic agents. - Details important refinements and developments in surgical techniques, including the Ross pulmonary autograft replacement of the aortic valve, video-assisted fluoroscopy, and the extracardiac Fontan connection, and discusses their indications and potential complications. - Explores the latest advances in the treatment of pulmonary hypertension, new developments in mechanical assist devices, heart and lung transplantation, and interventional cardiac catheterization. - Examines issues affecting adults with congenital heart disease.
Publisher: Elsevier Health Sciences
ISBN: 1455751006
Category : Medical
Languages : en
Pages : 1195
Book Description
**Selected for Doody's Core Titles® 2024 with "Essential Purchase" designation in Pediatric Surgery** Now in brilliant full color and reflecting recent significant changes in the field, Critical Heart Disease in Infants and Children, 3rd Edition, keeps you abreast of the skills and knowledge required to safely care for children with congenital and acquired heart disease in the ICU. Pediatric intensivists, cardiologists, cardiac surgeons, and anesthesiologists from leading centers around the world provide a well-rounded perspective on basic scientific principles, medical and pharmacologic treatments, surgical techniques, and equipment. - Features comprehensive updates throughout the text, including indications, techniques, potential complications in perioperative management of patients, and surgical techniques for congenital heart disease. - Covers recent advances in the treatment of pulmonary hypertension, developments in mechanical assist devices, heart and lung transplantation, and interventional cardiac catheterization. - Features an all-new, full-color format that speeds navigation and helps clarify complex concepts. - Contains 27 new chapters with an emphasis on the team approach to patient care in the ICU including creating multidisciplinary teams, quality and performance improvement, training , and challenges and solutions to developing a cohesive team environment. - Includes a detailed chapter on bedside ultrasound, walking you through the techniques you're most likely to encounter in the ICU. - Employs well-documented tables, text boxes, and algorithms to make clinical information easy to access, and more than two dozen video clips provide a more complete understanding of echocardiography, imaging modalities, pulmonary hypertension, and more. - Describes the basic pharmacology and clinical applications of new pharmacologic agents. - Examines issues affecting adults with congenital heart disease. - Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices. - Offers four completely new chapters: Cardiac Trauma, Congenital Heart Disease in the Adult, Congenitally Corrected Transposition of the Great Arteries, and Outcome Evaluation. - Describes the basic pharmacology and clinical applications of all of the new pharmacologic agents. - Details important refinements and developments in surgical techniques, including the Ross pulmonary autograft replacement of the aortic valve, video-assisted fluoroscopy, and the extracardiac Fontan connection, and discusses their indications and potential complications. - Explores the latest advances in the treatment of pulmonary hypertension, new developments in mechanical assist devices, heart and lung transplantation, and interventional cardiac catheterization. - Examines issues affecting adults with congenital heart disease.