The adult with congenital heart disease: medical and surgical considerations for management

Purpose of review The purpose of the present review is to outline some of the challenges of surgical and medical management in the adult with congenital heart disease (CHD). Recent findings The number of adult patients with CHD continues to grow. These patients require specialized care and there are few cardiologists and surgeons, as well as other subspecialists (e.g., anesthesia, hepatology, nephrology, etc.) with training who are comfortable in the management of this patient population. When operations on adults with CHD are performed by surgeons trained in congenital cardiac surgery, mortality rates and hospital costs are significantly lower than when performed by adult cardiac surgeons. Reoperations are frequent; peripheral vascular access may be compromised and sternal reentry is more likely to result in cardiac injury. End organ dysfunction, particularly liver and kidney, is not uncommon, further complicating perioperative care. Finally, adults with CHD may have complex psychosocial issues. A comprehensive multidisciplinary team approach can best address all of these issues. Summary Adults with CHDs present difficult challenges in the preoperative, intraoperative, and postoperative setting. Regional centers of excellence with congenitally-trained cardiac surgeons, cardiologists, and other medical subspecialists are required to optimize outcome.