Care of adults with congenital heart disease--a challenge for the new millennium.

The care of complex congenital heart defect (CHD) patients should be continuous through life. Medium- and high-risk patients should be seen in special facilities for grown-up congenital heart (GUCH) patients, and followed for life. CHD in the adult is different than CHD in the child. Transitional programs should be available to prepare the adolescent patient to take charge of his/her own health. The patient should be transferred smoothly from pediatric to adult care. GUCH care should be regionally anchored in special facilities (groups or sometimes individuals) willing to make a commitment to their care. Ideally, pediatric and adult cardiologists will collaborate. GUCH care should be multidisciplinary wherever possible--and certainly in supraregional centers. Surgery, diagnostic catheterization, interventional cath procedures, EP management, and even MRI should be done in selected centers with high quality services for all cases other than the most simple lesions. Care should be available at all times. Surgeons who operate on children with similar conditions should perform the most GUCH surgery. GUCH surgery should be performed in centers with adequate institutional and individual surgeon's volumes. In determining which surgeons and units have adequate volumes, both pediatric and adult volumes should be combined.