Palliated congenital heart disease.

The group of patients with palliated complex forms of congenital heart disease presents a challenging and difficult management problem during the adolescent years. In patients not considered to be candidates for more fully palliated procedures that separate the circulations, a bidirectional caval pulmonary shunt, often associated with a systemic to pulmonary shunt, may provide significant palliation for several more decades. However, there remain a significant number of patients who, after some years, may develop increasing problems associated with myocardial failure and the development of serious atrial arrhythmias. Interventional cardiac catheterization combined with newer surgical techniques may return many of these patients to more satisfactory hemodynamic states. However, some patients during their adolescent years may eventually require cardiac transplantation for the long-term management of their complex congenital cardiac defects.