Management of adults with congenital heart disease: an increasing problem.

A small new population of patients in cardiology, the grown-up (adult) congenital hearts (GUCH), need superspecialist care and expertise, particularly those patients with complex defects previously operated on in childhood or who were not operated on. Arrhythmias are the most common cardiologic reason for admission to the hospital, and atrial flutter is the most frequent disorder of rhythm, usually related to hemodynamic disturbances. The GUCHs need solutions to problems of transition of care, ideally an adolescent area for the younger patients, knowledge of which and when to investigate each anomaly, expertise in cardiac catheterization and interventions, cardiac surgeons experienced in congenital as well as adult disease since one in five admissions are for cardiac surgery, at-risk pregnancy service, counseling on life's problems, and most of all a few dedicated centers with cardiologists and surgeons trained in this subspecialty. The profession needs to achieve optimal care for these precious patients, particularly those with complicated lesions and complex surgery, particularly with the valve replacements. Although small in number and high in expense, GUCH patients should be centralized so expertise and experience can be concentrated despite the need to cross barriers of finance and bureaucracy. Currently, with the exception of a few expert centers, these patients receive suboptimal medical management.