Despite congenital heart malformations are currently treated in infancy and childhood, a great number of patients still need surgical treatment in adult age. This population is rapidly growing with increased social and medical challenges. The topic is discussed in 3 Sections, that give extensive analysis of the medical and surgical problems, popularize the international guidelines for treatment of congenital heart disease in adults, and report data of over 800 patients collected in a wide multicentric study involving 7 major italian centers, with more than 1000 surgical procedures. The surgical mortality and late death reported in this experience are satisfactory. Surgery for congenital heart disease in adult age is resulting to be a safe and beneficial treatment in most patients, who can live a productive and fulfilling life. However, patients with comorbidities (such as cyanosis, worse preoperative NYHA class) present additional risk. Early repair is advocated before onset of cardiac deconpensation and multiorgan failure.