Can CHD lead to complications later in life? 

The success of paediatric cardiac surgery means that the majority of children born with Congenital Heart Disease (CHD) now survive well into adulthood. However, it is a clinical reality that childhood operations are often palliative repairs rather than permanent cures. As the heart and body age, the unique anatomy of a repaired heart can lead to various complications. These issues can arise decades after the initial surgery, which is why specialist follow-up care is essential for maintaining health throughout adult life. 

What We Will cover in This Article 

• Why childhood heart repairs often require ongoing monitoring in adulthood. 

• Common cardiac complications, such as heart rhythm disorders and heart failure. 

• The impact of long-term pressure changes on heart valves and blood vessels. 

• Non-cardiac complications affecting the kidneys, liver, and lungs. 

• Psychological and neurocognitive challenges associated with lifelong CHD. 

• How the complexity of the original defect influences the risk of late issues. 

• The role of lifestyle factors in managing long-term cardiac health. 

Cardiac Complications in Adulthood 

The most frequent complications in adults with CHD involve the heart’s electrical system and its pumping efficiency. Surgical scars from childhood procedures can become triggers for abnormal heart rhythms, known as arrhythmias. These can manifest as atrial flutter or more serious ventricular tachycardias. Clinical data suggests that arrhythmias are the primary reason for hospitalisation among the adult CHD population. 

Heart failure is another significant concern. Over time, the heart muscle may become stiff or weak from years of pumping against altered pressures or handled increased blood volumes. This is particularly common in patients with complex repairs, such as those with Fontan circulation. Additionally, heart valves that were repaired or replaced in childhood may eventually leak or narrow as the materials wear out or as the patient’s body changes with age. 

• Arrhythmias: Often caused by scar tissue from previous surgeries. 

• Heart Failure: A gradual decline in the heart’s pumping or filling capacity. 

• Valvular Issues: Recurrent leaking (regurgitation) or narrowing (stenosis) of heart valves. 

• Pulmonary Hypertension: Increased pressure in the blood vessels of the lungs. 

Non-Cardiac and Multi-Organ Impact 

We now understand that CHD is a multi-system condition. The chronic changes in blood flow and oxygen levels can affect other organs over several decades. For instance, the kidneys and liver are highly sensitive to changes in cardiac output and venous pressure. Adults with CHD have a higher prevalence of chronic kidney disease and liver dysfunction compared to the general population. 

Furthermore, lung function can be affected by previous chest surgeries or underlying vascular issues. Beyond the physical, there is an increasing awareness of the psychological burden. Living with a chronic heart condition is linked to higher rates of anxiety, depression, and post-traumatic stress. Neurocognitive challenges, such as difficulties with memory or executive function, may also become more apparent as patients navigate the demands of adult life. 

Complication Risk by Defect Complexity 

The likelihood of developing late-onset complications is closely tied to the severity of the original heart defect. Specialist centres categorise patients into groups to help tailor their monitoring schedules. 

Defect Complexity	Examples	Common Late Complications
Simple	Small VSD, repaired ASD	Generally low risk; occasional valve leaks or mild arrhythmias.
Moderate	Tetralogy of Fallot, Coarctation	Valve replacements, heart failure, and atrial arrhythmias.
Complex	Fontan, Transposition (TGA)	High risk of heart failure, liver congestion, and complex arrhythmias.

The Importance of Lifelong Specialist Care 

The “care gap” is a major risk factor for complications. Many young adults stop seeing a heart specialist once they leave paediatric services, often because they feel healthy. However, many cardiac issues are “silent” in their early stages. By the time symptoms like breathlessness or palpitations appear, the heart may have already undergone significant stress. 

Regular reviews at an Adult Congenital Heart Disease (ACHD) centre allow for proactive management. This includes the use of advanced imaging like MRI and CT to spot structural changes early. Modern medicine also offers many non-surgical interventions, such as catheter-based valve replacements, which can treat complications without the need for traditional open-heart surgery. 

To Summarise 

In my final conclusion, while modern surgery allows most people with CHD to live long and active lives, the condition remains a lifelong journey. Complications such as heart failure, arrhythmias, and organ dysfunction can develop later in life as a consequence of the original defect or the subsequent repairs. Staying connected with a specialist cardiac team is the most effective way to detect these issues early and ensure that your heart remains as healthy as possible throughout your adult years. 

If you experience severe, sudden, or worsening symptoms, such as fainting, sudden crushing chest pain, or extreme difficulty breathing, call 999 immediately. 

Authority Snapshot (E-E-A-T Block) 

This article was written by Dr. Stefan Petrov, a UK-trained physician with an MBBS and experience in general medicine, surgery, and intensive care. Dr. Petrov emphasizes the importance of lifelong surveillance for cardiac patients to ensure early detection of late-onset sequelae. His guidance is grounded in the clinical standards for adult congenital heart disease, focusing on the prevention of morbidity through structured specialist follow-up.