Heart failure (HF) is a clinical syndrome with multiple causes. Patients with adult congenital
heart disease (ACHD) typically have more than 1 substrate for developing HF, including
prolonged cyanosis, myocardial damage related to multiple surgical and interventional
procedures, chronic pressure/volume loading related to residual lesions, intrinsic myocardial
disease, and HF secondary to arrhythmia. Clinical HF assessment is generally based on
symptoms (exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea), physical …