Congenital heart disease in adults (CHDA), commonly referred to as Grown-Up Congenital Heart Disease (GUCH), includes all patients with congenital heart defects who have reached adulthood. This includes not only heart conditions diagnosed and treated during childhood, which may progress to secondary decompensation, but also malformations that remain asymptomatic for a long time and only become clinically apparent in adulthood. These patients have specific pathophysiological and progressive characteristics that require specialized care and long-term follow-up [1].

Congenital heart disease is the most common congenital malformation, with an estimated global prevalence of between 8 and 10 per 1,000 live births [2].

Due to advances in diagnosis and pediatric cardiac surgery, a growing proportion of patients are now reaching adulthood, giving rise to the concept of grown-up congenital heart disease (GUCH) [3].

In resource-limited countries, many congenital heart diseases remain undiagnosed during childhood and are only diagnosed in adulthood, often at an advanced stage [4].

Late surgery then poses specific challenges related to anatomical changes, pulmonary hypertension, and associated comorbidities.

In Senegal, data on the surgical treatment of congenital heart disease in adults remains limited. This study aims to describe the experience of the CUOMO cardiac surgery department at the Fann University Hospital Center.

This is a retrospective, descriptive, longitudinal study conducted in the CUOMO pediatric cardiac surgery department at the Fann National University Hospital Center in Dakar from January 2017 to April 2023, over a period of 6 years and 4 months.

All patients aged 16 years or older who underwent surgery for confirmed congenital heart disease during the study period and had a usable medical record were included. All incomplete records and patients under the age of 16 were excluded.

The data were analyzed descriptively using frequencies, percentages, and means. Statistical analysis was performed using RSTUDIO version 2025 software. During the study period, 1,743 patients were treated at this center, and congenital heart disease in adults accounted for 1.6%, or 28 patients. Of these 28 patients, 13 were male and 15 were female, giving a sex ratio of 0.87. The average age of our patients was 24 years [16 - 53 years].

In our study, the hospital prevalence of congenital heart disease operated on in adulthood was 1.6%, confirming the relative rarity of these conditions in African hospitals compared to developed countries. Non-cyanotic congenital heart disease (NCCD) accounted for the vast majority of cases (96.4%), dominated by left-to-right shunts (71.4%), while cyanotic heart disease remained rare (3.6%).

These results are comparable to those reported in the international literature, particularly in Europe and North America, where improved screening and early management have changed the epidemiological profile of congenital heart disease in adults [1][5][6].

In sub-Saharan Africa, we have a prevalence of 0.75 % however, this figure is likely underestimated due to limited access to healthcare [7].

The study population was young, with a mean age of 24, lower than that reported in Western series, where the mean age often exceeds 40 [6][8].

This difference is mainly explained by late diagnosis and reduced life expectancy in the absence of early surgical correction.

A slight female predominance was observed, in line with several studies [1][7].

Dyspnea was the main presenting symptom (82.1%), most often classified as NYHA class II. This finding is consistent with data reported in the African and international literature, where dyspnea remains the predominant symptom revealing undiagnosed congenital heart disease during childhood [9].

ASD was the most common heart disease (32.1%), with a clear female predominance. The average age at the time of surgery was relatively young compared to other series [10].

The clinical manifestations were dominated by exertional dyspnea, and the paraclinical data confirmed right-sided heart failure.

Surgical management was based primarily on complete correction under cardiopulmonary bypass, with closure using a pericardial patch in most cases. Postoperative results were satisfactory, with low morbidity (10.7%) and zero mortality, in line with large international series [10][11].

VSD was the second most common heart disease. The majority of patients were male, with dyspnea being the predominant symptom. Perimembranous forms were predominant, in line with classic data in the literature [2].

Surgery, performed under cardiopulmonary bypass, resulted in effective correction with zero mortality and favorable short-and medium-term outcomes, despite longer operating times than those reported in some series [11].

AVCD accounted for 14.3% of cases, with a predominance of females. Partial forms were the majority. Clinical manifestations were dominated by dyspnea and auscultatory abnormalities. Surgery, although technically demanding, yielded good functional results and no postoperative mortality in our series, confirming the encouraging results reported in the literature [11].

Tetralogy of Fallot was the only cyanotic heart disease observed. The late diagnosis can be explained by the fact that the condition was relatively well tolerated by the patient. Despite an initially favorable postoperative course, late mortality was observed, highlighting the potential severity of these conditions when treated in adulthood, which is consistent with data reported in large international series [12].

Overall, postoperative morbidity was low, dominated by transient complications (anemia, residual shunts, etc.). Early mortality was virtually zero, confirming the safety of congenital heart surgery in adults when performed in specialized centers [13].

Short-and medium-term follow-up showed significant clinical improvement in the majority of patients, with an improved quality of life. However, the rare late complications observed highlight the importance of prolonged and structured follow-up [14].

This study highlights that surgery for congenital heart disease in adults is feasible with good functional outcomes and low mortality, even in a resource-limited setting. The predominance of non-cyanotic forms, the young age of patients, and good postoperative outcomes underscore the importance of early diagnosis and specialized care [1][15].

The development of dedicated facilities and the strengthening of long-term follow-up remain essential to further improve the prognosis for these patients.