Adult Congenital Heart Disease Handbook 2026: A Clinical Textbook Covering Lesion-Based Physiology, Diagnostic Reasoning, and Longitudinal Surveillance for ACHD Fellows

Reconstruct the Anatomy, Track the Threshold, Never Miss the TrapBuilt for the fellow and cardiologist who must turn a segmental echocardiogram or a decades-old operative report into today's decision, this handbook reconstructs adult congenital heart disease from embryology and anatomy outward into the surveillance thresholds and contraindications that govern this population's care. It moves lesion by lesion - septal defects, obstructive disease, tetralogy of Fallot, the transposition spectrum, Ebstein anomaly, the Fontan circulation, Eisenmenger physiology, and genetic aortopathy - into the lifelong management chapters where arrhythmia, heart failure, pregnancy, surgery, and endocarditis risk are recalibrated for structurally abnormal anatomy rather than borrowed unmodified from acquired-disease practice.Lesion-specific intervention thresholds, hemodynamic decision trees, and anatomy-matched anesthesia and pregnancy frameworks turn dense structural reasoning into decisions you can act on at the point of care.From the Segmental Echocardiogram to the Clinic Visit, You Will- Reconstruct any complex anatomy through sequential situs, connection, and looping analysis - reasoning that replaces a memorized label with actual physiology.- Time septal defect closure by objective chamber size and pressure criteria, not murmur intensity or symptom report.- Separate unrepaired tetralogy of Fallot from Eisenmenger physiology, and time pulmonary valve replacement by right ventricular volume, not symptoms.- Track systemic right ventricular failure across the atrial switch and congenitally corrected transposition populations as one integrated surveillance target.- Recognize Fontan circulatory decline before any single dramatic finding forces the diagnosis, and identify when Fontan conversion is actually indicated.- Exclude fixed Eisenmenger physiology by catheterization before closing any shunt in a cyanotic adult - one of this field's most consequential contraindications.- Calibrate arrhythmia, heart failure, mWHO pregnancy risk, and surgical management to abnormal anatomy instead of unmodified acquired-disease protocols.- Navigate every named-feature instance through the ACHD Circuit Master Atlas, indexing all twenty-three chapters by clinical scenario.This population's silence, not its symptoms, is what its lifelong care depends on - open this handbook before the next visit that looks routine.