ABSTRACT
The surgical approach to treat the different types of congenital heart diseases (CHD) has been modified ever since. Surgical skills and techniques continue to improve, operative techniques and procedures change and evolve, and the body of experience with individual types of surgery grows. Therefore, on long-term follow-up of adults with CHD, the physician must bear in mind the period when the patient had surgery as well as the possibility of intraoperative injury to the heart. Many of our adults with CHD were cyanotic for many years during childhood, with subsequent ischemia/hypoxia of the myocardium, necrosis and fibrosis. These may be morphologic substrates for arrhythmias during adulthood. Operation of CHD may result in conduction system injury with subsequent development of bundle branch block, or complete atrioventricular block. Surgery in childhood often results in pericardial adhesions. These may cause problems during reoperation, and may also contribute to diastolic ventricular dysfunction and render cardiac chamber dilatation impossible.
