Congenital heart disease in adults

Patients reaching adulthood with unoperated and operated congenital heart disease require attention to issues of exercise, antibiotic prophylaxis, contraception, and pregnancy. A careful clinical history is important to establish the degree of a person's disability, if any, and the symptoms responsible for the disability, whether due to heart failure, cyanosis, or both. The findings of a physical examination and a noninvasive evaluation, including electrocardiogram, chest x-ray film, and echocardiography, are often sufficient to establish a diagnosis and to assess the adequacy of a previous operation. Transesophageal echocardiography and magnetic resonance imaging are adjunctive procedures that are indicated when routine transthoracic echocardiography is limited. Cardiac catheterization may be necessary when the noninvasive data are ambiguous and to assess coronary artery disease (congenital and acquired) in patients considered for surgical therapy. Cardiac catheterization is increasingly therapeutic (such as percutaneous pulmonary balloon valvuloplasty) as well as diagnostic. Primary surgical repair or additional surgical palliative procedures should be considered in symptomatic adults. A patient with Eisenmenger's syndrome--severe pulmonary hypertension--is a special case that may be amenable only to transplantation.