2025 Key Updates in the Care of Adults with Congenital Heart Disease

Recent recommendations of the American College of Cardiology/American Heart Association Joint Committee emphasize that adults with congenital heart disease achieve better outcomes when managed at specialized adult congenital heart disease (ACHD) centers with multidisciplinary teams and close involvement of ACHD cardiologists, particularly for patients with moderate or complex anatomy or physiology. Expert ACHD input is advised for both cardiac and noncardiac procedures, with attention to anesthesia, perioperative management, and the evaluation of endocarditis in bioprosthetic pulmonary valve dysfunction, now formally incorporated into physiological staging. Updated guidance supports vaginal delivery for most pregnant patients with appropriate risk stratification, refines criteria for pulmonary valve replacement and arrhythmia management in repaired tetralogy of Fallot, expands closure recommendations for secundum atrial septal defect with pulmonary hypertension, and favors rhythm control strategies for atrial arrhythmias in complex ACHD. Additional updates address guideline-directed medical therapy and pacing considerations for heart failure in ACHD, the use of pulmonary vasodilators in Eisenmenger syndrome, and systematic liver disease surveillance in Fontan patients, including annual testing and hepatology consultation. Source: https://www.jacc.org/