Challenges posed by adults with repaired congenital heart disease.

Abstract

“Pediatric Congenital Cardiac Becomes a Postoperative Adult: The Changing Population of Congenital Heart Disease,” which was written in 1973,1 was the first publication devoted to what was destined to become a new field of special cardiovascular interest. Subsequent decades witnessed the maturity of this new subspecialty, which was formally recognized at the 22nd Bethesda Conference in 1990.2 It is altogether fitting for Circulation to include the present article in “Clinical Cardiology: New Frontiers.” The present article can be considered a sequel to the 1973 article, which dealt with the types of surgical interventions, the effects of those interventions on survival patterns, the desirability of primary anatomic repair in infancy, and the importance of postoperative residua and sequelae.1 The 1973 article opened by stating: “It is now possible to perform palliative or corrective surgery on almost all congenital cardiac anomalies, even the most complex … Survival patterns are affected, often profoundly. We are therefore confronted with a changing population of congenital cardiacs … However, we are obliged to look beyond the present and define our ultimate goal. What do we seek to accomplish? The answer is clear. Our efforts should focus on the quality of long-term survival.”1 Long-term survival is chiefly concerned with the growing number of postoperative patients who require continuing medical surveillance.3 What is needed is a new generation of cardiologists with a career interest in adult congenital heart disease; these highly trained specialists function best within tertiary care facilities designed for the comprehensive care of adult patients. With few exceptions, such facilities are part of major university hospital systems. Major facilities draw patients regionally, nationally, and internationally. The geographic distribution of tertiary care centers will best be determined by the quality of the facility and the services offered rather than by external constraints …