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Pediatric cardiac care has advanced over the past decade and many children born with heart defects have been operated and managed resulting in improvement of outcome and life expectancy. This review focuses on patients born with left-to-right shunts that survive into adulthood and we believe it is important for the adult primary care physician to realize that more and more patients with congenital heart defects will enter into their practice over the next several decades as improvements in childhood cardiac care continue to be made. Although the field of adult congenital heart disease continues to grow and advance, the number of cardiologists specifically trained in this area are not yet adequate to deal with the growing amount of patients with these conditions. This requires a concerted effort from cardiologists of both adult and pediatric specialties, but perhaps more importantly from the multitude of primary care physicians that will most probably be the only physicians many of these patients will ever see. Many adult patients born with left-to-right heart lesions underwent treatment and repair early in childhood and might not have felt it necessary to continue follow-up with a cardiologist. Many other patients with these defects might have survived to adulthood without diagnosis and could present to the primary care provider with new symptoms that finally developed. Primary care physicians will most certainly be at the frontlines of caring for these congenital heart defects.

Adults with left-to-right cardiac shunts and with shunts treated in childhood