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

The care of complex congenital heart defect (CHD) patients should be contin uous 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 pr ograms should be available to prepare the adolescent patient to take charge of his/her own health. The patient should be transferred smoothly from ped iatric to adult care. GUCH care should be regionally anchored in special fa cilities (groups or sometimes individuals) willing to make a commitment to their care. Ideally, pediatric and adult cardiologists will collaborate. GU CH care should be multidisciplinary wherever possible - and certainly in su praregional centers. Surgery, diagnostic catheterization, interventional ca th procedures, EP management, and even MRI should be done in selected cente rs with high quality services for all cases other than the most simple lesi ons. Care should be available at all times. Surgeons who operate on childre n with similar conditions should perform the most GUCH surgery. GUCH surger y should be performed in centers with adequate institutional and individual surgeon's volumes. In determining which surgeons and units have adequate v olumes, both pediatric and adult volumes should be combined.