Abstract
Over the past several decades, the total number of adult patients with congenital heart disease has rapidly risen due to advances in early surgery and medical management. The current prevalence of adult congenital heart disease is now approximately 3000 per million adults. With these successes, new challenges also emerge. In this heterogeneous group of patients, several factors can contribute to the development of heart failure. For instance, longstanding right ventricular volume overload in the tetralogy of Fallot patients can lead to heart failure, while patients with a Mustard or Senning repair of transposition of the great arteries may develop heart failure after systemic right ventricle deterioration due to pressure overload. Heart failure in adult congenital heart disease is a continuum from mild ventricular dysfunction and modest neurohormonal activation to hospitalization for symptomatic heart failure and is associated with a decreased life expectancy depending on the severity.In this review, we discuss the prevalence and etiology of heart failure in adult patients with congenital heart disease. More in detail, we discuss whether several well-established markers in acquired heart failure have a (potential) role in the diagnosis and risk stratification of heart failure in adult congenital heart disease patients. Finally, opportunities in prevention and treatment are discussed as well as future perspectives on the problem of heart failure in adult congenital heart disease.
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