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European Heart Journal 2003 24(10):970-976; doi:10.1016/S0195-668X(03)00005-8
Copyright © 2003 by the European Society of Cardiology.
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Congenital heart disease: the original heart failure syndrome

Aidan P Bolgera,b,*, Andrew J.S Coatsb and Michael A Gatzoulisa

a Adult Congenital Heart Programme, Royal Brompton Hospital, London, UK
b Department of Clinical Cardiology, National Heart and Lung Institute, Dovehouse Street, London SW3 6LY, UK

* Corresponding author. Tel.: +44-20-7351-8127; fax: +44-20-7351-8733
E-mail address: a.bolger{at}ic.ac.uk

Received 4 October 2002; accepted 10 December 2002

Heart failure is characterised by a triad comprising cardiac abnormality, exercise limitation and neurohormonal activation. The 2% of the adult population who suffer with heart failure are known to derive both symptomatic and prognostic benefit from exercise and pharmacologic neurohormonal antagonism. The existence of heart failure has traditionally been considered in the context of ischaemic, hypertensive, valvular and myopathic disease but in this article we develop the argument that patients with congenital heart disease also manifest all the pathophysiological criteria that constitute the chronic heart failure syndrome. We discuss the inherent limitations to a purely anatomical approach to congenital heart disease, bring attention to the large and rapidly growing population of adults with this condition and conclude by calling for a therapeutic approach to congenital heart disease that is based on the heart failure paradigm.

Key Words: Congenital heart disease • Heart failure • Neurohormonal activation


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