Ana Barradas-Pires

More than a century ago, Victor Eisenmenger published the case of a “powerfully-built” man in his thirties with longstanding cyanosis and effort-induced breathlessness, who eventually developed heart failure, oedema and died suddenly following “violent” haemoptysis. The patient, who was found to have a large ventricular septal defect (VSD) on autopsy, represented the first case in the scientific literature of what would posthumously be called Eisenmenger complex.

Sex and gender have been used interchangeably in the cardiovascular (CV) literature for many years. Nevertheless, these are quite different concepts, and the World Health Organisation (WHO) defines sex as a biological character assigned at birth, which depends on the combination of genetic material (sex chromosomes) and hormonal regulators (sex hormones). Sex is used as dichotomous variable (male versus female), which excludes rare chromosomic abnormalities.

Highlights • Heart failure is the leading cause of death in adults with congenital heart disease (CHD). • Heart transplantation can be an effective therapy, but there is uncertainty about patient selection criteria and timing for transplantation. • There is high overall mortality among CHD patients with heart failure, with good long-term outcomes after transplantation. • Only a small percentage of patients assessed finally undergo transplantation.