Cardiac surgery in adults with congenital heart disease: an emerging challenge.

over the last 20 to 30 years has allowed a large number of neonates, infants and children with congenital heart diseases to survive until adulthood. As a result, while in former times the term “congenital heart disease” applied mainly to childhood (since adults with congenital heart disease, then encountered only rarely, usually had fewer complications and a relatively benign natural history), today it is estimated that the steadily growing number of adults with congenital heart diseases has probably overtaken the number of child patients. The adult population with congenital heart disease (grownup congenital heart disease) has important peculiarities and requirements. The spectrum of anomalies and the complexity of the postoperative anatomy and pathophysiology may extend beyond the training and experience, not only of most cardiologists who deal with adults, but also of cardiac surgeons who are involved only with general cardiac surgery in adults. On the other hand, pediatric cardiologists who wish to continue to follow their patients as they grow into maturity often have difficulties when they are asked to treat acquired heart conditions and other adult diseases that afflict those patients. Similar problems are faced by pediatric cardiac surgeons who have given up surgery in adults—for example, as a result of working exclusively in pediatric centers. Consequently, there is an increased need for centers that bring together the skills of cardiac surgeons and cardiologists or pediatric cardiologists who have knowledge and experience of congenital heart disease in adults. Recognizing the importance of this problem, at its 32nd Meeting in Bethesda (2-3 October, 2000) the American College of Cardiology endorsed an investigation into the subject: “Care of the Adult with Congenital Heart Disease.” The associated report was published in the College’s journal in the spring of 2001.