Therefore, for cardiologists, one marker of ACHD expertise is board eligibility/board certification in ACHD. There are expert ACHD cli- nicians who are not board-certified, including those whose expertise was acquired before the development of formal certification programs and those trained outside the United States who may also have different pathways to achieve ACHD ex- pertise. Expertise in the surgical management of patients with ACHD may be identified through board eligibility/board certification in congenital heart surgery. There are expert ACHD surgeons who are not board-certified, including those sur- geons trained in other countries who are not eligi- ble for certification in the United States. Specific ACHD training options are not gen- erally available for cardiac anesthesiologists, but many of them develop expertise through training in pediatric anesthesiology, cardiac anesthesiology, mentoring, and practice experience. Other provid- ers involved in the care of patients with ACHD (eg, obstetricians, pulmonologists, radiologists, nurse practitioners, physician assistants) derive expertise from training and/or practice. Individual provid- ers may gain ACHD expertise in a specific area or discipline, such as intraoperative transesophageal echocardiography (TEE) or interpretation of CMR. 2. Patients with ACHD who are undergoing in- vasive cardiovascular procedures in specialized ACHD centers generally have better outcomes, including survival, than those managed in other Special attention is required to ensure appropriate periprocedural care, including identification of procedure-related risk factors and availability of ancillary imaging.S3.3-3 S3.3-10 Table 6 addresses delivery of care where circumstances of ACHD expertise may improve patient outcomes. 3.4. Evaluation of Suspected and Known CHD Tools commonly used in the evaluation of adults with suspected or known acquired cardiovascular disease CLINICAL STATEMENTS AND GUIDELINES Table 6. 