Evaluation may also include exercise testing to assess func- Careful evaluation of hemo- dynamic status for optimization of management Potentially treatable residual hemodynamic problems may be identified dur- ing hemodynamic evaluation, such as outflow tract stenosis or significant regurgitation, which may benefit from either catheter or surgical Patients with markedly reduced ventricular function, elevated end-diastolic pressures, or pulmonary hypertension should be treated for underlying hemodynamic problems as part of their arrhyth- mia management. 2. The correlation of residual hemodynamic abnor- malities with VA has been most extensively studied in patients with repaired TOF, where RV hyperten- sion, residual pulmonary outflow tract obstruction or regurgitation, and RV dilation are risk factors In these studies, frequent PVCs correlated with risk of clinical or inducible sustained VT. A com- bined approach of surgery for structural abnor- malities with map-guided arrhythmia surgery has been used with success,S10.8-3,S10.8-8,S10.8-10,S10.8-12 but elimination of VT circuits may be limited by deep endocardial or LV origin of VT and limitations of operative mapping; an empiric approach to VT surgery is generally not recommended as it has limited effectiveness and carries risk of ventricu- Pulmonary valve replace- ment in patients with TOF may result in improved hemodynamics and functional status, but it may not eliminate the risk of VTS10.8-3,S10.8-12 ; postopera- tive reassessment for the need for an ICD is per- formed after the early recovery period. 3. Correction of residual hemodynamic/structural abnormalities contributing to VT may improve ventricular function and reduce symptoms, but Recommendations for Adult Congenital Heart Disease (Continued) COR LOE Recommendations CLINICAL STATEMENTS AND GUIDELINES it may inadequately prevent the risk of subse- quent VT or SCA. 