Heart failure in congenital heart disease in adults

Abstract

Heart failure is a common complication in adult patients with congenital heart disease, and it significantly increases their mortality. The multifactorial etiology of heart failure in CHD includes not only morphological findings pertinent to particular congenital defects or residua following catheterization and surgical procedures, but also dysfunction of the left or right ventricles in the systemic or subpulmonary positions. When examining patients with heart failure, in addition to conventional examination techniques, it is advisable to perform serial exercise tests and NT-proBNP assessments allowing to monitor the progression of heart failure over time. The mainstay of treatment in patients with heart failure is elimination of the causes, whether by surgery or catheterization, and of the causative factors, which very often include arrhythmias. Evidence-based medical therapy is only relevant to the systemic left ventricle, with all the other haemodynamic arrangements rather requiring a creative approach based on experience. Heart transplantation is an ultimate option with very good long-term results; however, it is associated with a high mortality on the waiting list.