Overview of Adult Congenital Heart Disease
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Patients Whose Childhood Corrections Require Revision

Most of the procedures performed on adults with CHD are re-operations - modifications or revisions of procedures that were performed in childhood. While a patient may have received the state-of-the-art repair in their day, additional operations may be necessary because the original repair has lost some of its effectiveness, or because of the development of new anomalies that have developed around or on previous repairs. Before performing a "re-operation," the surgeon must become thoroughly familiar with the patient's previous procedures, including any complications.

Some common examples of re-operations performed on adults with CHD are the following:

> Repair of valves or conduits that wear out or cease to function properly (prosthetic or otherwise). This can be particularly common for the adult Tetralogy of Fallot patient as these patients can end up requiring pulmonic valve replacement as a consequence of their right ventricular outflow tract being enlarged during their initial TOF repair. In adulthood many of these patients develop pulmonic insufficiency with right-sided heart failure requiring pulmonic valve replacement. A recent study has shown that valves and conduits last at least 20 years after insertion for 40% of patients.

> Repair of a recurrent coarctation (re-coarctation) of the aorta, in which the aorta once again becomes constricted. This problem may be complicated by aortic valvular disease, a reduction in the size of the aortic arch, and/or the formation of aneurysms on the ascending aorta.

> Repair of obstructions that develop in the systemic or pulmonary veins after atrial repair for Transposition of the Great Arteries or endocarditis (infection of the interior lining of the heart). Successful treatment is usually achieved by enlarging the vein diameter with a balloon and/or by the insertion of a stent.

> Repair of complications after the Fontan Procedure. There are several kinds of difficulties that may arise in the years after this operation, requiring various treatments. In particular, some of the earliest Fontan repairs have required revision to lateral tunnels due to a patient's having a large right atrial appendage that could be a nidus (place of origin) for clots.