Congenital heart disease in the adult: a review with internet-accessible transesophageal echocardiographic images.

T he number of adults recognized with congenital heart disease (CHD) has increased dramatically over the past five decades because of significant advances in diagnosis and medical and surgical care. At the moment, the population of adults with CHD (ACHD) in the United States is estimated at approximately one million (1). For the first time, the number of adults with congenital cardiovascular malformations equals the number of children with these disorders. With additional refinements in surgical techniques and definitive repair at an earlier age, this patient group is likely to increase even further. Survival rates in CHD are influenced by many factors, including year of birth, age at diagnosis, complexity of the pathology, and whether the lesion(s) has been palliated or surgically corrected (Table 1) (1). As survival and life expectancy continue to improve, a growing number of unoperated, palliated, and “repaired” individuals require surgical interventions or other procedures related or unrelated to their heart disease. The care of these patients is becoming more frequent in all surgical settings, including tertiary care facilities, ambulatory centers, and labor and delivery suites. Adults with CHD may come to the attention of anesthesiologists for various indications including: