How much follow-up do patients need after repair of acyanotic heart disease?

It remains unproven that scheduled follow-up after repair of acyanotic heart defects actually prolongs life or improves its quality. However, postoperative patients do occasionally encounter late complications that, when recognized, can be treated effectively. Scheduled follow-up probably maximizes the early recognition and treatment of late postoperative problems. Each repaired defect has a best-case scenario for long-term course, in which late complications are relatively unlikely. The best cases after repair of certain lesions, for example patent ductus arteriosus, carry negligible potential for deterioration and so benefit less from frequent technologically intensive follow-up than others, such as aortic stenosis, that have greater potential for deterioration. Residual hemodynamic or electrophysiologic problems (including pulmonary or systemic hypertension, residual valvular insufficiency or stenosis, heart failure, atrioventricular block, or tachyarrhythmias) identify some patients as special cases who deviate from the best-case scenario in ways that make deterioration more likely. Although best cases can usually be followed infrequently with minimal technologic support, special cases require more active management to optimize their outcome, so they should benefit from more frequent and extensive scheduled follow-up. Failure to appreciate the heterogeneity of follow-up needs among patients who share the same preoperative diagnosis can lead to inappropriately standardized levels of postoperative surveillance, providing too much for some and not enough for others.