Surgical considerations in adult patients with congenital heart disease

The number of adults with congenital heart disease (CHD) has dramatically increased over the past decades. It is estimated that more than a million adults with CHD are in the United States alone (Hoffman, Am Heart J 147:425-439, 2004) and it is expected that this number will continue to grow as the population increases. This is secondary to the significant improvement in cardiac surgery and perioperative care. Now, at least 95 % of newborns with CHD will survive to adulthood (Warnes, J Am Coll Cardiol 46:1-8, 2005); however, despite this improvement, residual or recurrent lesions may progress over years and decades resulting in an increase in the need for reoperation. Valve procedures are the most common, and many patients may require numerous surgical procedures or interventions over a lifetime. This chapter will review the surgical issues associated with reoperation in adults with CHD and discuss the role of available imaging modalities in the perioperative management of this growing patient population.