{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T12:07:49Z","timestamp":1788782869272,"version":"build-2803163510"},"reference-count":106,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Cardiovasc. Dev. Dis.","JCDD"],"abstract":"<jats:p>(1) Background: In routine clinical practice, CHDs are occasionally diagnosed in adulthood, mostly relatively minor defects that become symptomatic later in life. Less frequently, adults may present with complex CHDs that, due to anatomical variations, remain undiagnosed until adulthood. Another important group comprises patients with previously unrecognized CHDs, particularly those from socioeconomically disadvantaged settings with limited access to healthcare. (2) Body: In adulthood, CHDs often present with nonspecific symptoms suggestive of other cardiovascular conditions (cardiomyopathy or coronary artery disease), including dyspnea, chest discomfort, signs of HF, syncope, palpitations, and paradoxical embolism. The initial manifestation may also be a malignant arrhythmia or sudden cardiac death; therefore, early recognition and diagnosis are crucial. TTE represents the first-line diagnostic modality. Reduced LVEF in young patients, particularly when accompanied by left atrial and right-sided cardiac chamber dilatation, should raise suspicion of an underlying CHD. The diagnostic evaluation may be supplemented by TEE, CMR imaging, and right heart catheterization. Familial forms of CHD and the risk of transmission to offspring have been extensively investigated, particularly for conditions with a strong genetic component, such as BAV. (3) Conclusions: In adult patients with newly diagnosed CHD, accurate recognition of clinical symptoms and completion of an appropriate diagnostic workup are essential for establishing the diagnosis and initiating timely treatment. Furthermore, identification of families at increased genetic risk is important to facilitate targeted genetic panel screening. Future research should focus on developing and validating appropriate screening strategies for the early detection of CHDs in resource-limited regions.<\/jats:p>","DOI":"10.3390\/jcdd13090438","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T10:30:46Z","timestamp":1788777046000},"page":"438","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Delayed Diagnosis of Congenital Heart Diseases in Adults: Opportunities for Improving Diagnostic Strategies"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3687-1310","authenticated-orcid":false,"given":"Rea","family":"Levicki","sequence":"first","affiliation":[{"name":"Department of Cardiology, Po\u017eega General Hospital, 34000 Po\u017eega, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zrinko","family":"Pe\u0161ut","sequence":"additional","affiliation":[{"name":"Department of Cardiology, General Hospital \u201cDr. Josip Ben\u010devi\u0107\u201d, 35000 Slavonski Brod, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lora","family":"Levicki","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Osijek, \u201cJosip Juraj Strossmayer\u201d University of Osijek, 31000 Osijek, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2417-1811","authenticated-orcid":false,"given":"Ivan","family":"Vukoja","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Po\u017eega General Hospital, 34000 Po\u017eega, Croatia"},{"name":"Faculty of Medicine Osijek, \u201cJosip Juraj Strossmayer\u201d University of Osijek, 31000 Osijek, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,6]]},"reference":[{"key":"ref_1","first-page":"221","article-title":"Adult congenital heart disease","volume":"4","author":"Moodie","year":"2002","journal-title":"Ochsner J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.12968\/hmed.2021.0302","article-title":"Adult congenital heart disease: A review of the simple lesions","volume":"83","author":"Prica","year":"2022","journal-title":"Br. J. Hosp. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.case.2022.09.010","article-title":"Undiagnosed Atrial Septal Defect in the Setting of Comorbidities and Ventricular Failure: Seemingly Simple Disease with a Challenging Diagnosis","volume":"7","author":"Sadeghpour","year":"2023","journal-title":"CASE"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"4783","DOI":"10.1093\/eurheartj\/ehae716","article-title":"Adults with congenital heart disease: What every cardiologist should know about their care","volume":"45","author":"Budts","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_5","first-page":"195","article-title":"Adults with congenital heart disease\u2014A new, expanding group of patients","volume":"120","author":"Stiller","year":"2023","journal-title":"Dtsch. \u00c4rztebl. Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1161\/CIRCULATIONAHA.114.011190","article-title":"Progress in Late Results Among Pediatric Cardiac Surgery Patients: A Population-Based 6-Decade Study with 98% Follow-Up","volume":"131","author":"Raissadati","year":"2015","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1136\/pgmj.2005.044495","article-title":"Delayed recognition of congenital heart disease","volume":"82","author":"Massin","year":"2006","journal-title":"Postgrad. Med. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"320","DOI":"10.4103\/apc.APC_35_20","article-title":"Birth prevalence and late diagnosis of critical congenital heart disease: A population-based study from a middle-income country","volume":"13","author":"Sapian","year":"2020","journal-title":"Ann. Pediatr. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3963","DOI":"10.1016\/j.radcr.2022.07.084","article-title":"Complete interruption of aortic arch diagnosed in adulthood: A case report","volume":"17","author":"Sharma","year":"2022","journal-title":"Radiol. Case Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2431","DOI":"10.1016\/j.jacc.2023.05.009","article-title":"Ebstein Anomaly","volume":"81","author":"Connolly","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.cjcpc.2025.06.003","article-title":"Uncorrected Dextro\u2013Transposition of the Great Arteries with Intact Ventricular Septum and Atrial Septal Defect Diagnosed After Developing Heart Failure","volume":"5","author":"Goto","year":"2026","journal-title":"CJC Pediatr. Congenit. Heart Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1093\/ehjci\/jet170","article-title":"Late diagnosis of a congenital apical ventricular septal defect with complete closure by right ventricular trabeculations","volume":"15","author":"Grittner","year":"2014","journal-title":"Eur. Heart J.-Cardiovasc. Imaging"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1186\/s13256-025-05239-6","article-title":"Navigating the clinical complexity of acute heart failure in an untreated adult with dextrotransposition of the great arteries (D-TGA) and multiple cardiac anomalies: A case report and review of literature","volume":"19","author":"Mecha","year":"2025","journal-title":"J. Med. Case Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1921","DOI":"10.1016\/S0140-6736(13)62145-5","article-title":"Atrial septal defects","volume":"383","author":"Geva","year":"2014","journal-title":"Lancet"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"100208","DOI":"10.1016\/j.acepjo.2025.100208","article-title":"Syncope as the First Clue to a Congenital Heart Defect","volume":"6","author":"Soni","year":"2025","journal-title":"JACEP Open"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"111223","DOI":"10.1016\/j.ijscr.2025.111223","article-title":"A case report of dyspnea that revealed a congenital left cardiac diverticulum of discovery in adulthood with a fatal course","volume":"129","author":"Jebali","year":"2025","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_17","first-page":"1066","article-title":"Characteristics of adult patients with atrial septal defects presenting with paradoxical embolism","volume":"74","author":"Bannan","year":"2009","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"103901","DOI":"10.1016\/j.jaccas.2025.103901","article-title":"Undiagnosed Perimembranous Ventricular Septal Defect. Presenting as Congestive Heart Failure in an Elderly Woman","volume":"30","author":"Panduranga","year":"2025","journal-title":"JACC Case Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"CMC.S15715","DOI":"10.4137\/CMC.S15715","article-title":"Atrial Septal Defects\u2014Clinical Manifestations, Echo Assessment, and Intervention","volume":"8","author":"Martin","year":"2014","journal-title":"Clin. Med. Insights Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"105220","DOI":"10.1016\/j.jaccas.2025.105220","article-title":"Coronary Embolism from a Sinus Venosus ASD with PAPVD","volume":"30","author":"Lin","year":"2025","journal-title":"JACC Case Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2940","DOI":"10.1002\/ehf2.13378","article-title":"Heart Failure Related to Adult Congenital Heart Disease: Prevalence, Outcome and Risk Factors","volume":"8","author":"Arnaert","year":"2021","journal-title":"ESC Heart Fail."},{"key":"ref_22","first-page":"e67063","article-title":"Management of Fallot\u2019s Uncorrected Tetralogy in Adulthood: A Narrative Review","volume":"16","author":"Kaiser","year":"2024","journal-title":"Cureus"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Alipour Symakani, R.S., van Genuchten, W.J., Zandbergen, L.M., Henry, S., Taverne, Y.J.H.J., Merkus, D., Helbing, W.A., and Bartelds, B. (2023). The right ventricle in tetralogy of Fallot: Adaptation to sequential loading. Front. Pediatr., 11.","DOI":"10.3389\/fped.2023.1098248"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1016\/0002-9149(72)90504-8","article-title":"Tetralogy of fallot in the adult","volume":"29","author":"Higgins","year":"1972","journal-title":"Am. J. Cardiol."},{"key":"ref_25","first-page":"e69339","article-title":"Unveiling Congenital Heart Disease in an Octogenarian: A Case of Late Diagnosis of Patent Ductus Arteriosus Presenting with Heart Failure with a Preserved Ejection Fraction","volume":"16","author":"Saleem","year":"2024","journal-title":"Cureus"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/j.tcm.2016.04.004","article-title":"Extra-cardiac manifestations of adult congenital heart disease","volume":"26","author":"Gaeta","year":"2016","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2385","DOI":"10.1161\/CIRCULATIONAHA.115.011241","article-title":"Stroke in Adults with Congenital Heart Disease: Incidence, Cumulative Risk, and Predictors","volume":"132","author":"Lanz","year":"2015","journal-title":"Circulation"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Zubrzycki, M.P., Schramm, R., Costard-J\u00e4ckle, A., Morshuis, M., Gummert, J.F., and Zubrzycka, M. (2024). Pathogenesis and surgical treatment of dextro-transposition of the great arteries (D-TGA): Part II. J. Clin. Med., 13.","DOI":"10.3390\/jcm13164823"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1093\/eurheartj\/ehaa554","article-title":"2020 ESC Guidelines for the management of adult congenital heart disease","volume":"42","author":"Baumgartner","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.cjcpc.2025.12.001","article-title":"De Novo Heart Failure in a 32-Year-Old Man from Congenital Ostial Left Main Coronary Atresia","volume":"5","author":"Wang","year":"2025","journal-title":"CJC Pediatr. Congenit. Heart Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/j.amjcard.2003.11.031","article-title":"An echocardiographic survey of primary school children for bicuspid aortic valve","volume":"93","author":"Basso","year":"2004","journal-title":"Am. J. Cardiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2789","DOI":"10.1016\/j.jacc.2009.12.068","article-title":"Bicuspid Aortic Valve Disease","volume":"55","author":"Siu","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2776","DOI":"10.1161\/CIRCULATIONAHA.107.740878","article-title":"Natural History of Asymptomatic Patients with Normally Functioning or Minimally Dysfunctional Bicuspid Aortic Valve in the Community","volume":"117","author":"Michelena","year":"2008","journal-title":"Circulation"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"361","DOI":"10.4065\/80.3.361","article-title":"Left Heart Lesions in Patients with Ebstein Anomaly","volume":"80","author":"Jost","year":"2005","journal-title":"Mayo Clin. Proc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"A314","DOI":"10.1016\/j.chest.2025.07.182","article-title":"The hidden challenge: Late-diagnosed Ebstein\u2019s anomaly and the battle against postsurgical complications","volume":"168","author":"Vazquez","year":"2025","journal-title":"Chest"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.athoracsur.2017.09.058","article-title":"Improving Results of Surgery for Ebstein Anomaly: Where Are We After 235 Cone Repairs?","volume":"105","author":"Holst","year":"2018","journal-title":"Ann. Thorac. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e031760","DOI":"10.1161\/JAHA.123.031760","article-title":"Arrhythmia Burden Among Adult Patients with Congenital Heart Disease: A Population-Based Study","volume":"13","author":"Nir","year":"2024","journal-title":"J. Am. Heart Assoc."},{"key":"ref_38","first-page":"201","article-title":"The disposition of the conduction tissues in congenitally malformed hearts with reference to their embryological development","volume":"19","author":"Anderson","year":"1991","journal-title":"J. Perinat. Med."},{"key":"ref_39","first-page":"1719","article-title":"Arrhythmias in congenital heart disease: A position paper of the European Heart Rhythm Association (EHRA), Association for European Paediatric and Congenital Cardiology (AEPC), and the European Society of Cardiology (ESC) Working Group on Grown-up Congenital heart disease, endorsed by HRS, PACES, APHRS, and SOLAECE","volume":"20","author":"Paul","year":"2018","journal-title":"EP Eur."},{"key":"ref_40","first-page":"1337","article-title":"Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement","volume":"15","author":"Brugada","year":"2013","journal-title":"EP Eur."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e028956","DOI":"10.1161\/JAHA.122.028956","article-title":"Arrhythmias and Clinical Outcomes in a Swiss Multicenter Cohort of Patients with Dextro-Transposition of the Great Arteries and Atrial Switch","volume":"12","author":"Nozica","year":"2023","journal-title":"J. Am. Heart Assoc."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1046\/j.1540-8167.2001.00671.x","article-title":"Atrioventricular Reciprocating Tachycardia Involving Twin Atrioventricular Nodes in Patients with Complex Congenital Heart Disease","volume":"12","author":"Epstein","year":"2001","journal-title":"Cardiovasc. Electrophysiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1016\/j.jacc.2023.06.034","article-title":"Ventricular Arrhythmias in Adults With Congenital Heart Disease, Part I","volume":"82","author":"Waldmann","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.case.2017.05.003","article-title":"Cor Triatriatum Sinister with Secundum Atrial Septal Defect","volume":"1","author":"Lambert","year":"2017","journal-title":"CASE"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Correra, A., Mauriello, A., Di Peppo, M., D\u2019Andrea, A., Russo, V., Esposito, G., and Brunetti, N.D. (2025). Atrial Septal Defect and Heart Rhythm Disorders: Physiopathological Linkage and Clinical Perspectives. Biomedicines, 13.","DOI":"10.3390\/biomedicines13102427"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e001056","DOI":"10.1136\/openhrt-2019-001056","article-title":"Hidden burden of arrhythmias in patients with small atrial septal defects: A nationwide study","volume":"6","author":"Udholm","year":"2019","journal-title":"Open Heart"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/S0003-4975(99)00478-6","article-title":"Incidence of atrial flutter\/fibrillation in adults with atrial septal defect before and after surgery","volume":"68","author":"Berger","year":"1999","journal-title":"Ann. Thorac. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1017\/S1047951111000795","article-title":"Right bundle branch block as a marker for interatrial septal abnormalities","volume":"22","author":"Bakalli","year":"2012","journal-title":"Cardiol. Young"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"154245","DOI":"10.1016\/j.jelectrocard.2026.154245","article-title":"Electrocardiographic P-wave amplitude as a discriminative marker for pediatric atrial septal defects","volume":"97","author":"Kumamoto","year":"2026","journal-title":"J. Electrocardiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1055\/s-2000-6897","article-title":"Ebstein\u2019s Anomaly in Adults. Arrhythmias: Diagnosis and Therapeutic Approach","volume":"48","author":"Hebe","year":"2000","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1161\/CIRCULATIONAHA.106.619338","article-title":"Ebstein\u2019s Anomaly","volume":"115","author":"Connolly","year":"2007","journal-title":"Circulation"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e264","DOI":"10.1016\/j.landig.2025.01.001","article-title":"Electrocardiogram-based deep learning to predict left ventricular systolic dysfunction in paediatric and adult congenital heart disease in the USA: A multicentre modelling study","volume":"7","author":"Mayourian","year":"2025","journal-title":"Lancet Digit. Health"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.ijcard.2018.07.058","article-title":"Consensus recommendations for echocardiography in adults with congenital heart defects from the International Society of Adult Congenital Heart Disease (ISACHD)","volume":"272","author":"Li","year":"2018","journal-title":"Int. J. Cardiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1016\/j.annemergmed.2015.07.525","article-title":"Pulmonary Hypertension and Right Ventricular Failure in Emergency Medicine","volume":"66","author":"Wilcox","year":"2015","journal-title":"Ann. Emerg. Med."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Lindor, R.A., Heller, K., Hodgson, N.R., Kishi, P., Monas, J., Rappaport, D., Thomas, A., Urumov, A., Walker, L.E., and Majdalany, D.S. (2024). Adult Congenital Heart Disease in the Emergency Department. J. Pers. Med., 14.","DOI":"10.3390\/jpm14010066"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1741","DOI":"10.1017\/S1047951120002656","article-title":"Cyanosis Due to an Isolated Atrial Septal Defect: Case Report and Review of the Literature","volume":"30","author":"Krasemann","year":"2020","journal-title":"Cardiol. Young"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"S2953","DOI":"10.21037\/jtd.2018.08.92","article-title":"Atrial Septal Defects and Pulmonary Arterial Hypertension","volume":"10","author":"Nashat","year":"2018","journal-title":"J. Thorac. Dis."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"103","DOI":"10.4103\/apc.APC_122_17","article-title":"Coronary Sinus Atrial Septal Defect without Persistent Left Superior Vena Cava: Three-Dimensional Imaging of a Rare Defect","volume":"11","author":"Quadros","year":"2018","journal-title":"Ann. Pediatr. Cardiol."},{"key":"ref_59","first-page":"2915","article-title":"2020 ESC Guidelines for the Management of Adult Congenital Heart Disease: The Task Force for the Management of Adult Congenital Heart Disease of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Adult Congenital Heart Disease (ISACHD)","volume":"31","author":"Baumgartner","year":"2010","journal-title":"Eur. Heart J."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/S0735-1097(83)80385-4","article-title":"Sensitivity of two-dimensional echocardiography in the direct visualization of atrial septal defect utilizing the subcostal approach: Experience with 154 patients","volume":"2","author":"Shub","year":"1983","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.case.2021.12.002","article-title":"Multimodality Imaging of Sinus Venosus Atrial Septal Defect: A Challenging Diagnosis in Adults","volume":"6","author":"Qiu","year":"2022","journal-title":"CASE"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"2660","DOI":"10.1093\/eurheartj\/ehab646","article-title":"Atrial septal defect in adulthood: A new paradigm for congenital heart disease","volume":"43","author":"Brida","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_63","first-page":"100335","article-title":"Imaging of ventricular septal defect: Native and post-repair","volume":"7","author":"Fusco","year":"2022","journal-title":"Int. J. Cardiol. Congenit. Heart Dis."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.ihj.2013.03.003","article-title":"Stepwise evaluation of left to right shunts by echocardiography","volume":"65","author":"Awasthy","year":"2013","journal-title":"Indian Heart J."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"48","DOI":"10.4250\/jcu.2015.23.1.48","article-title":"Double Chambered Right Ventricle with Ventricular Septal Defect in Adults: Case Series and Review of the Literature","volume":"23","author":"Moustafa","year":"2015","journal-title":"J. Cardiovasc. Ultrasound"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/1058-9813(93)90042-X","article-title":"Embryology and pathologic features of Ebstein\u2019s anomaly","volume":"2","author":"Edwards","year":"1993","journal-title":"Prog. Pediatr. Cardiol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1111\/j.1540-8175.1993.tb00082.x","article-title":"Ebstein\u2019s Anomaly: Ultrasound Imaging and Hemodynamic Evaluation","volume":"10","author":"Seward","year":"1993","journal-title":"Echocardiography"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/S0003-4975(99)01265-5","article-title":"Congenital Heart Surgery Nomenclature and Database Project: Ebstein\u2019s anomaly and tricuspid valve disease","volume":"69","author":"Dearani","year":"2000","journal-title":"Ann. Thorac. Surg."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/S0025-6196(25)19027-7","article-title":"Morphologic Spectrum of Ebstein\u2019s Anomaly of the Heart","volume":"54","author":"Anderson","year":"1979","journal-title":"Mayo Clin. Proc."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"G95","DOI":"10.1530\/ERP-20-0033","article-title":"Echocardiographic assessment of the tricuspid and pulmonary valves: A practical guideline from the British Society of Echocardiography","volume":"7","author":"Zaidi","year":"2020","journal-title":"Echo Res. Pract."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Cri\u0219an, S., B\u0103ghin\u0103, R.M., Luca, S., P\u0103tru, O., Laz\u0103r, M.A., V\u0103c\u0103rescu, C., Rus, M., Cozma, D., Gai\u021b\u0103, D., and Luca, C.T. (2024). From ECG to Imaging: Challenges in the Diagnosis of Adult Congenital Heart Diseases. J. Clin. Med., 13.","DOI":"10.3390\/jcm13164865"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1016\/j.amjcard.2010.10.058","article-title":"Cardiac Magnetic Resonance Imaging and the Assessment of Ebstein Anomaly in Adults","volume":"107","author":"Yalonetsky","year":"2011","journal-title":"Am. J. Cardiol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.1016\/S0140-6736(09)60657-7","article-title":"Tetralogy of Fallot","volume":"374","author":"Apitz","year":"2009","journal-title":"Lancet"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1016\/0002-9149(78)90941-4","article-title":"Life expectancy without surgery in tetralogy of fallot","volume":"42","author":"Bertranou","year":"1978","journal-title":"Am. J. Cardiol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/1750-1172-4-2","article-title":"Tetralogy of Fallot","volume":"4","author":"Bailliard","year":"2009","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"276","DOI":"10.36502\/2025\/ASJBCCR.6427","article-title":"Late Presentation of Tetralogy of Fallot and Uncommon Survival in A 31-Year-Old Patient","volume":"8","author":"Usman","year":"2025","journal-title":"Asploro J. Biomed. Clin. Case Rep."},{"key":"ref_77","first-page":"827","article-title":"Surviving Unrepaired Tetralogy of Fallot to 43 Years in a Low-Resource Setting: The Oldest Reported Case from Somalia","volume":"18","author":"Warfaa","year":"2025","journal-title":"Int. Med. Case Rep. J."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/S0735-1097(86)80040-7","article-title":"Patent ductus arteriosus in adults-long-term follow-up: Nonsurgical versus surgical treatment","volume":"8","author":"Fisher","year":"1986","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1111\/j.1747-0803.2008.00224.x","article-title":"Abdominal Aortic Pulsed Wave Doppler Patterns Reliably Reflect Clinical Severity in Patients with Coarctation of the Aorta","volume":"3","author":"Silvilairat","year":"2008","journal-title":"Congenit. Heart Dis."},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Leo, I., Sabatino, J., Avesani, M., Moscatelli, S., Bianco, F., Borrelli, N., de Sarro, R., Leonardi, B., Calcaterra, B., and Surkova, E. (2023). Non-Invasive Imaging Assessment in Patients with Aortic Coarctation: A Contemporary Review. J. Clin. Med., 13.","DOI":"10.3390\/jcm13010028"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1007\/s10554-016-0838-8","article-title":"Quantitative assessment of systolic left ventricular function with speckle-tracking echocardiography in adult patients with repaired aortic coarctation","volume":"32","author":"Menting","year":"2016","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1093\/ehjci\/jeab165","article-title":"Prognostic implications of left heart diastolic dysfunction in adults with coarctation of aorta","volume":"22","author":"Egbe","year":"2021","journal-title":"Eur. Heart J.-Cardiovasc. Imaging"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1016\/j.jtcvs.2007.01.039","article-title":"A classification system for the bicuspid aortic valve from 304 surgical specimens","volume":"133","author":"Sievers","year":"2007","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_84","first-page":"48","article-title":"Reliability of transthoracic echocardiography in the assessment of aortic valve morphology: Pathological correlation in 178 patients","volume":"15","author":"Chan","year":"1999","journal-title":"Can. J. Cardiol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"a036749","DOI":"10.1101\/cshperspect.a036749","article-title":"Genetic Basis of Human Congenital Heart Disease","volume":"12","author":"Nees","year":"2020","journal-title":"Cold Spring Harb. Perspect. Biol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.1038\/ng.3970","article-title":"Contribution of rare inherited and de novo variants in 2,871 congenital heart disease probands","volume":"49","author":"Jin","year":"2017","journal-title":"Nat. Genet."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1007\/s00246-011-0034-5","article-title":"The Contribution of Chromosomal Abnormalities to Congenital Heart Defects: A Population-Based Study","volume":"32","author":"Hartman","year":"2011","journal-title":"Pediatr. Cardiol."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"e11","DOI":"10.1542\/peds.101.1.e11","article-title":"Cardiovascular Malformations and Complications in Turner Syndrome","volume":"101","author":"Sybert","year":"1998","journal-title":"Pediatrics"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1111\/chd.12317","article-title":"Familial Atrial Septal Defect and Sudden Cardiac Death: Identification of a Novel NKX2-5 Mutation and a Review of the Literature: NKX2-5 Mutations in Familial ASD and Sudden Cardiac Death","volume":"11","author":"Johansen","year":"2016","journal-title":"Congenit. Heart Dis."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1038\/nature01827","article-title":"GATA4 mutations cause human congenital heart defects and reveal an interaction with TBX5","volume":"424","author":"Garg","year":"2003","journal-title":"Nature"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.jacc.2004.03.050","article-title":"Bicuspid aortic valve is heritable","volume":"44","author":"Cripe","year":"2004","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1007\/s00439-006-0316-9","article-title":"Evidence in favor of linkage to human chromosomal regions 18q, 5q and 13q for bicuspid aortic valve and associated cardiovascular malformations","volume":"121","author":"Martin","year":"2007","journal-title":"Hum. Genet."},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"Nakanishi, T., Markwald, R.R., Baldwin, H.S., Keller, B.B., Srivastava, D., and Yamagishi, H. (2016). Notch Signaling in Aortic Valve Development and Disease. Etiology and Morphogenesis of Congenital Heart Disease, Springer.","DOI":"10.1007\/978-4-431-54628-3"},{"key":"ref_94","doi-asserted-by":"crossref","unstructured":"Budde, B.S., Binner, P., Waldm\u00fcller, S., H\u00f6hne, W., Blankenfeldt, W., Hassfeld, S., Br\u00f6msen, J., Dermintzoglou, A., Wieczorek, M., and May, E. (2007). Noncompaction of the Ventricular Myocardium Is Associated with a De Novo Mutation in the \u03b2-Myosin Heavy Chain Gene. PLoS ONE, 2.","DOI":"10.1371\/journal.pone.0001362"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1161\/CIRCULATIONAHA.109.857987","article-title":"Recurrence of Congenital Heart Defects in Families","volume":"120","author":"Poulsen","year":"2009","journal-title":"Circulation"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"S31","DOI":"10.1017\/S1047951117002591","article-title":"Management of late presentation congenital heart disease","volume":"27","author":"Iyer","year":"2017","journal-title":"Cardiol. Young"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.1136\/archdischild-2015-308173","article-title":"Paediatric cardiac surgery in low-income and middle-income countries: A continuing challenge","volume":"100","author":"Nguyen","year":"2015","journal-title":"Arch. Dis. Child."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1007\/s12055-024-01771-0","article-title":"Late presentation of congenital heart diseases in low- and middle-income countries: Impact on outcomes","volume":"41","author":"Das","year":"2025","journal-title":"Indian. J. Thorac. Cardiovasc. Surg."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1017\/S1047951107001588","article-title":"Management of patients with congenitally malformed hearts in Indonesia","volume":"17","author":"Rahajoe","year":"2007","journal-title":"Cardiol. Young"},{"key":"ref_100","first-page":"107","article-title":"Natural history of atrial septal defect with pulmonary hypertension: Follow-up of medically treated patients over 16 years of age","volume":"24","author":"Hayakawa","year":"1994","journal-title":"J. Cardiol."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/0002-8703(87)90315-2","article-title":"Ventricular septal defect in the adult: Natural and unnatural history","volume":"114","author":"Ellis","year":"1987","journal-title":"Am. Heart J."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1136\/hrt.32.5.633","article-title":"Natural history of coarctation of the aorta","volume":"32","author":"Campbell","year":"1970","journal-title":"Heart"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1136\/heartjnl-2014-305690","article-title":"Survival prospects of treatment na\u00efve patients with Eisenmenger: A systematic review of the literature and report of own experience","volume":"100","author":"Diller","year":"2014","journal-title":"Heart"},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Ejaz, H., Thyyib, T., Ibrahim, A., Nishat, A., and Malay, J. (2023). Role of artificial intelligence in early detection of congenital heart diseases in neonates. Front. Digit. Health, 5.","DOI":"10.3389\/fdgth.2023.1345814"},{"key":"ref_105","doi-asserted-by":"crossref","unstructured":"Sakai, A., Komatsu, M., Komatsu, R., Matsuoka, R., Yasutomi, S., Dozen, A., Shozu, K., Arakaki, T., Machino, H., and Asada, K. (2022). Medical Professional Enhancement Using Explainable Artificial Intelligence in Fetal Cardiac Ultrasound Screening. Biomedicines, 10.","DOI":"10.3390\/biomedicines10030551"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/ehjdh\/ztaa017","article-title":"Artificial intelligence-assisted auscultation in detecting congenital heart disease","volume":"2","author":"Lv","year":"2021","journal-title":"Eur. Heart J.-Digit. Health"}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/9\/438\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:13:32Z","timestamp":1788779612000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/9\/438"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,6]]},"references-count":106,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcdd13090438"],"URL":"https:\/\/doi.org\/10.3390\/jcdd13090438","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,6]]}}}