Advances in surgical management of congenital heart disease in adults.

The spectrum of congenital heart anomalies presenting in adults varies somewhat from that in children. Prolonged exposure to hypoxemia coupled with volume overload or pressure overload can produce myocardial fibrosis and ventricular dysfunction, which complicates surgical correction. Despite these difficulties, surgical correction is possible for most congenital heart lesions in adults, with subsequent improvement in symptoms and survival paralleling that achieved after repair in childhood. In the future, cardiologists and cardiac surgeons will encounter an additional subgroup of adults with congenital heart problems. These are patients who have survived initial correction or palliation of complex heart diseases and later develop complications owing to failure of abnormal native valves or prosthetic valves, narrowing of surgically created conduits, or intrinsic ventricular failure. Such patients will add to the challenge of evaluation and treatment of adults with congenital heart disease.