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Right ventricular outflow tract obstruction In valvular PS, balloon valvuloplasty is the intervention of choice, if anatomically suitable. I C Provided that no valve replacement is required, RVOTO intervention at any level is recommended regardless of symptoms when the stenosis is severe (Doppler peak gradient is >64 mmHg). I C If surgical valve replacement is the only option, it is indicated in patients with severe stenosis who are symptomatic. I C If surgical valve replacement is the only option in patients with severe stenosis who are asymptomatic, it is indicated in the presence of one or more of the following:  Objective decrease in exercise capacity.  Decreasing RV function and/or progression of TR to at least moderate.  RVSP >80 mmHg.  RL shunting via an ASD or VSD. I C Ebstein anomaly Surgical repair is recommended in patients with severe TR and symptoms or objective deterioration of exercise capacity. I C It is recommended that surgical repair is performed by a congenital surgeon with specific experience in Ebstein surgery. I C If there is an indication for TV surgery, ASD/PFO closure is recommended at the time of valve repair if it is expected to be haemodynamically tolerated. I C In patients with symptomatic arrhythmias or pre-excitation on the ECG, electrophysiologic testing followed by ablation therapy, if feasible, or surgical treatment of the arrhythmias in the case of planned heart surgery is recommended. I C After repair of tetralogy of Fallot PVRep is recommended in symptomatic patients with severe PR and/or at least moderate RVOTO. I C In patients with no native outflow tract, catheter intervention (TPVI) should be preferred if anatomically feasible. I C Transposition of the great arteries after atrial switch operation In symptomatic patients with pulmonary venous atrium obstruction, surgical repair (catheter intervention rarely possible) is recommended. I C In symptomatic patients with baffle stenosis not amenable to catheter intervention, surgical repair is recommended. I C In symptomatic patients with baffle leaks not amenable to catheter-based closure, surgical repair is recommended. I C PA banding in adults, as LV training with subsequent arterial switch procedure, is not recommended. III C In symptomatic patients with baffle stenosis, stenting is recommended when technically feasible. I C In symptomatic patients with baffle leaks and cyanosis at rest or during exercise, or with strong suspicion of paradoxical emboli, stenting (covered) or device closure is recommended when technically feasible. I C In patients with baffle leaks and symptoms due to LR shunt, stenting (covered) or device closure is recommended when technically feasible. I C Transposition of the great arteries after arterial switch operation Stenting or surgery (depending on substrate) is recommended for coronary artery stenosis causing ischaemia. I C Congenitally corrected transposition of the great arteries In symptomatic patients with severe TR and preserved or mildly impaired systemic RV systolic function (EF >40%), TV replacement is indicated. I C Right ventricular to pulmonary artery conduits Symptomatic patients with RVSP >60 mmHg (may be lower in case of reduced flow) and/or severe PR should undergo intervention with preference for catheter intervention (TPVI) if anatomically feasible. I C Univentricular heart It is recommended that adults with unoperated or palliated UVHs undergo careful evaluation in specialized centres, including multimodality imaging as well as invasive work-up to decide whether they may benefit from surgical or interventional procedures. I C After Fontan operation Sustained atrial arrhythmia with rapid AV conduction is a medical emergency and should be promptly treated with electrical cardioversion. I C Anticoagulation is indicated in the presence, or with a history, of atrial thrombus, atrial arrhythmias, or thromboembolic events. I C It is recommended that women with a Fontan circulation and any complication are counselled against pregnancy. I C Cardiac catheterization is recommended at a low threshold in cases of unexplained oedema, exercise deterioration, newonset arrhythmia, cyanosis, and haemoptysis. I C

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