Grown Up Congenital Heart Disease (GUCH) Clinic

Marelli et al.estimated the prevalence of CHD from 1985 to 2000 for children and adults and also found a shift in the population living with CHD to those > 18 years of age. Therefore, with further improvements in diagnostic and therapeutic options, the population of adults with CHD will only continue to increase

Many patients with simple lesions who have undergone total corrective surgery will have few if any hemodynamic residual requiring infrequent evaluation and treatment (e.g., atrial septal defects [ASD], ventricular septal defects [VSDs], patent ductus arteriosus [PDA], and mild pulmonary stenosis). Patients with more complex lesions, or complications that stem from less complex lesions, such as residual shunts, valvular disease, ventricular dysfunction, and arrhythmias require more frequent evaluation, medical treatment, and consideration for further surgical or catheter-based interventions. As we continue to learn about surgically altered CHDs, some “routine” patients will have previously unrecognized problems. For other adults, surgical approaches of the past and their long-term complications (e.g., D-TGA s/p Mustard or Senning Atrial Repair) will eventually become obsolete and replaced by new complications of present day surgical repair. The success of pediatric cardiology and CHD surgery is tempered by the long-term complications in adult patients that may involve every subspecialty within the field of cardiology (Fig. 68.5). By far, the most concerning of these long-term complications is sudden cardiac death (SCD)