CLINICAL CHARACTERISTICS, MANAGEMENT STRATEGIES, AND CLINICAL OUTCOMES OF ADULTS WITH CONGENITAL HEART DISEASE AT A TERTIARY CARE HOSPITAL IN PAKISTAN

Abstract

Objective: To assess the clinical presentation, management approaches, and short-term outcomes among adult patients with congenital heart disease (ACHD) presenting to a tertiary care hospital in Peshawar, Pakistan. Methodology: This cross-sectional study was conducted in the Department of Pediatric Cardiology and Intensive Care Unit (ICU) at Lady Reading Hospital, Peshawar, Pakistan, from March 2025 to November 2025. Patients of either gender, aged 18 years or older, with a confirmed diagnosis of congenital heart disease were included in the study. Data regarding demographic characteristics, clinical presentation, type of congenital heart defect, therapeutic interventions, and clinical outcomes were collected and analyzed. Outcomes were assessed in terms of intra-operative or postoperative mortality and postoperative complications. Results: A total of 129 patients with adult congenital heart disease were included, of whom 68 (52.7%) were male. The median age of the patients was 22.00 years. Ten (7.8%) patients were newly diagnosed with congenital heart disease during the study period. The most frequently observed congenital heart defects were tetralogy of Fallot (TOF), atrial septal defect (ASD), and ventricular septal defect (VSD), accounting for 32 (24.8%), 25 (19.4%), and 22 (17.1%) cases, respectively. The most common presenting complaints were shortness of breath, cyanosis, and palpitations, reported in 120 (93.0%), 48 (37.2%), and 44 (34.1%) patients, respectively. Cardiac catheterization was the most frequently performed intervention, carried out in 41 (31.8%) patients. Total correction, VSD closure, and ASD closure were performed in 9 (7.0%), 7 (5.4%), and 7 (5.4%) patients, respectively. No intra-operative or postoperative mortality was recorded. The most frequently documented postoperative complications were left ventricular dysfunction in 39 (30.2%), right ventricular dysfunction in 23 (17.9%), biventricular dysfunction in 6 (4.7%), and ventricular hypertrophy in 3 (2.3%) patients. Conclusion: Tetralogy of Fallot, atrial septal defect, and ventricular septal defect were the most commonly encountered congenital heart diseases among adults in this study. A considerable proportion of patients required surgical or catheter-based interventions. Despite the complexity of the underlying cardiac conditions, favorable short-term outcomes were observed, with no intra-operative or postoperative mortality reported. 

KEYWORDS: Adult congenital heart disease, Atrial septal defect, Cardiac catheterization, Congenital heart disease, Tetralogy of Fallot, Ventricular septal defect.