The writing committee included represent- atives from the ACC, AHA, and American Association for Thoracic Surgery (AATS), American Society of Ech- ocardiography (ASE), Heart Rhythm Society (HRS), In- ternational Society for Adult Congenital Heart Disease (ISACHD), Society for Cardiovascular Angiography and Interventions (SCAI), and the Society of Thoracic Sur- geons (STS). 1.3. Document Review and Approval This document was reviewed by 3 official reviewers each nominated by the ACC and AHA, and 1 to 2 reviewers each from the AATS, ASE, HRS, ISACHD, SCAI, STS; and 32 individual content reviewers. Re- viewers RWI information was distributed to the writ- ing committee and is published in this document (Appendix 2). This document was approved for publication by the governing bodies of the ACC and the AHA and endorsed by the AATS, ASE, HRS, ISACHD, SCAI, and STS. 1.4. Scope of the Guideline The 2018 ACHD guideline is a full revision of the 2008 ACC/AHA Guidelines for the Management of Adults with Congenital Heart Disease, S1.4-1 which was the first US guideline to be published on the topic. This revision uses the 2008 ACHD guideline as a framework and incorporates new data and growing ACHD expertise to develop recommendations. Con- genital heart disease (CHD) encompasses a range of structural cardiac abnormalities present before birth attributable to abnormal fetal cardiac develop- ment but does not include inherited disorders that may have cardiac manifestations such as Marfan syn- drome or hypertrophic cardiomyopathy. Also not in- cluded are anatomic variants such as patent foramen ovale. Valvular heart disease (VHD) may be congen- ital, so management overlaps with the 2014 AHA/ ACC Guidelines for the Management of Patients With Valvular Heart Disease, S1.4-2 particularly for bicuspid aortic valve (BAV) disease. 