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. Delivery of Care: Circumstances Where ACHD Expertise May Improve Outcomes Circumstance Possible Solution Rationale Example Care of patients in the lowest ACHD AP classification (IA)* Face-to-face consultation with an ACHD cardiologist. Patients in ACHD AP classification IA* are likely to be asymptomatic and not require frequent routine congenital cardiac care. Patients with small VSDs are thought to have excellent long-term survival, although complications (double-chamber RV, IE, aortic valve prolapse and aortic regurgitation) may manifest in adulthood; consequently, patients with small VSDs warrant lifelong Collaborative care planning between an ACHD patient s general cardiologist or primary care provider and an ACHD cardiologist. The very long-term outcomes of patients with ACHD AP classification IA* lesions have not been well described, although available data suggest that patients with simple CHD have higher cardiac mortality in long-term follow-up than age-matched controls.S3.3-11 Consultation with an ACHD cardiologist should help to accurately assess the patient s ACHD AP class, provide information regarding potential long-term outcomes, and reinforce signs and symptoms that should prompt further evaluation. Cardiac imaging of patients with ACHD Imaging studies should be performed and interpreted by individuals with expertise in CHD imaging. The complexity and variability of lesions, repairs, and sequelae in CHD constrain the use of standard protocols and sequences and often require modification of plans during acquisition of images, as well as specialized skills in interpretation. Thus, CHD expertise is helpful for optimal quality and interpretation of cardiac imaging studies. 