E-table 1. Institutional Requirements of a Specialist GUCH Centre: Specialities and
Subspecialities that must be available on site

Cardiology (including electrophysiology laboratory)

Paediatric cardiology

Congenital Heart surgery

Adult cardiac surgery

Anaesthesiology

Intensive care medicine

Gynaecology and obstetrics

Radiology

Internal medicine (nephrology, hepatology, infectious disease, pneumology,
gastroenterology, endocrinology, rheumatology, haematology and oncology)

General Surgery

Nuclear medicine

Human genetics

Neurology

Orthopaedics

Microbiology

Ophtalmology

Ear, Nose & Throat

Psychology/psychosomatics/psychiatry

Pathology

Rehabilitation medicine

Palliative medicine

Work/sports/social medicine
E-table 2. Types of Adult Congenital Heart Disease of Great Complexity*

Conduits, valved or nonvalved

Cyanotic congenital heart (all forms)

Double-outlet ventricle

Double-inlet ventricle

Eisenmenger syndrome
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
Fontan procedure

Mitral atresia

Pulmonary atresia (all forms)

Pulmonary vascular obstructive disease

Transposition of the great arteries

Tricuspid atresia

Truncus arteriosus

Other abnormalities of atrioventircular of ventriculoarterial connection not included
above (ie, crisscross heart, isomerism, heterotaxy syndromes, ventricular inversion)
*Modified from Warnes CA, Liberthson R, Danielson GK et al. Task force 1:the changing profile of
congenital heart disease in adult life. J Am Coll Cardiol 2001;37:1170-5[2]
E-table 3. Types of Adult Congenital Heart Disease of Moderate Complexity*

Aorto-left ventricular fistulas

Anomalous pulmonary venous connection (partial or total)

Atrioventricular septal defects (partial, intermediate or complete)

Coarctation of the aorta

Ebstein´s anomaly

Infundibular right ventricular outflow obstruction

Patent ductus arteriosus (not closed)

Pulmonary valve regurgitation (moderate to severe)

Pulmonary valve stenosis (moderate to severe)

Sinus of Valsalva fistula/aneurysm

Sinus venosus defect

Subvalvular or supravalvular aortic stenosis

Tetralogy of Fallot

Ventricular septal defect with
aortic regurgitation
coarctation of the aorta
mitral disease
right ventricular outflow tract obstruction
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straddling tricuspid/mitral valve
subaortic stenosis
*Modified from Warnes CA, Liberthson R, Danielson GK et al. Task force 1:the changing profile of
congenital heart disease in adult life. J Am Coll Cardiol 2001;37:1170-5[2]
E-table 4. Subspecialty GUCH: General knowledge and experience*

Principles of the embryology of the heart and the great vessels

Pathological anatomy of CHD (see e-table 2 and 3 for defects)

Pathophysiology of CHD (see e-table 2 and 3 for defects)

Knowledge of clinical genetics and of the genetic background of CHD, knowledge of
syndromes (e.g. Trisomy 21, Marfan´s syndrome etc.), principles of genetic
counseling

Knowledge of the natural history of CHD, of surgical and interventional treatment
(palliative and “corrective”) and post-interventional course (residua and sequalae,
long-term outcome, long-term complications)

Physical examination of CHD (presentation of CHD during adult life)

Indications and interpretation, strength and limitations, and possible complications of
the diagnostic procedures in CHD

Electrocardiogram (ECG), exercise ECG and Holter monitoring in CHD

Imaging techniques in the pre- and postoperative morphologic and functional
assessment of CHD (echocardiography, magnetic resonance imaging, multislice
computed tomography)

Interpretation of hemodynamic and angiographic findings from cardiac catheterization
in CHD

Indications for intervention and re-intervention in CHD (surgical and catheter)

Knowledge of surgical treatment in CHD (palliative, corrective, transplantation) and
perioperative management

Knowledge of interventional therapy in CHD (balloon valvotomy, valve implantation,
closure of shunt lesions, balloon dilatation and stenting of obstructive arterial and
venous obstruction, occlusion of vessels)
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
Diagnosis and treatment of heart failure in CHD (taking into account the difference
between CHD and acquired heart disease)

Diagnosis and treatment of pulmonary hypertension in CHD

Diagnosis, drug treatment and interventional treatment of arrhythmias in CHD
(pathophysiology, non-invasive diagnosis, invasive diagnosis, drug therapy, electrical
and interventional therapy [cardioversion, transitory stimulation, pacemakers, ICDs,
catheter ablation])

Knowledge of acquired cardiovascular disease (atherosclerosis, valvular heart disease,
hypertension etc.) and its prevention, diagnosis and treatment

Knowledge of medical co-morbidities (pulmonary, renal, hepatic etc.)

Risk assessment of pregnancy in CHD and management of pregnancy, delivery and
postpartum period

Risk assessment of non-cardiac surgery in CHD and perioperative management

Knowledge of psychosocial issues in CHD

Knowledge of recommendations for physical activity in GUCH (sports, occupation)

Knowledge of insurance issues, holding of driver´s licence etc in GUCH
*Adapted from [8] (German recommendations qualification in GUCH)
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