The grown-up congenital heart disease dilemma in India: A call for urgent reform in adult congenital cardiac care

Grown-up with congenital heart disease (GUCH) represents an emerging but under-recognized public health challenge in India. With an estimated 3.5 million adults living with congenital heart disease (CHD), the country has one of the world’s largest GUCH populations. Despite improving pediatric cardiac surgery outcomes, adult CHD care remains fragmented, with critical gaps in infrastructure, training, transition protocols, and national policy. This editorial explores the epidemiological burden, systemic challenges, and recent progress, including the growth of pediatric cardiac programs, the emergence of GUCH clinics, and increased use of transcatheter interventions for the Indian GUCH patients. We need a structured, level-based care model, development of specialized centers, dedicated GUCH training, and the creation of national registries and India-specific guidelines. Bridging the divide between pediatric and adult cardiology is essential to ensure lifelong, coordinated care for this vulnerable population.