Long-term follow-up of operated congenital heart disease.

The long-term follow-up status of patients operated upon for the more common forms of congenital heart disease is reviewed. Among patients with large left-to-right shunts the long-term prognosis for those with ASD and VSD is generally excellent. With rare exceptions, these patients can look forward to a normal adulthood. Residual atrioventricular valve disease complicates the long-term course of infants and children operated upon for atrioventricular canal, but nevertheless, most patients have remained stable for many years. Among patients after relief of right ventricular outflow tract obstruction, excellent documentation of long-term stability has been reported for children with valvular pulmonary stenosis, and most patients with tetralogy of Fallot appear to tolerate residual right ventricular outflow stenosis and insufficiency without serious complications. Dysrrhythmias occur, but severe sequelae are rare. The prognosis for survivors of pulmonary atresia with VSD is more guarded. Conduit longevity appears to be the most important concern, and long-term studies indicate that xenografts rarely last beyond a decade. The modern types of homografts cannot yet be evaluated on a long-term basis. For patients with pulmonary atresia and intact ventricular septum, there are a number of long-term survivors, but most have chronic right heart dysfunction with only a rare, outstanding result. The long-term outlook for patients with left ventricular outflow obstruction is guarded. Most patients after repair of aortic stenosis have residual aortic stenosis and/or insufficiency. Postaortic valvotomy adults tend to be symptom-free, despite residual disease, but almost certainly late management will be required.(ABSTRACT TRUNCATED AT 250 WORDS)