Congenital heart disease in the 21st century

Paediatric cardiac surgery is now a mature specialty, yielding good results for those born with congenital heart disease (CHD). The current status of this surgery is considered, highlighting progress in genetic studies, improvements in intensive care management, and contemporary management of the low cardiac output syndrome. Emerging issues include the neurodevelopmental status of patients undergoing cardiac surgery, and known issues with the Fontan circulation. A framework for considering adults with CHD is described, including a review of common procedures and expected outcomes. Similarities and differences between routine adult cardiac intensive care and care of adults with CHD are also discussed. Some patients classed as the "successes" of paediatric cardiac programs, as well as those with known persisting problems, need close follow-up in adult facilities. There is every indication that significant numbers of patients with complex disease are now entering a phase of life when late complications may present. Some overlap in experience between paediatric and adult care settings is invaluable in providing optimal care.