Pediatricians and cardiologists are faced with an emerging population of older children and young adults who have congenital or acquired heart disease. Improved diagnostic techniques and pathophysiological understanding allow for better diagnosis and treatment, especially for those with more severe cardiac disorders. A larger group of young people has asymptomatic congenital heart disease that does not require intervention, but stigmatizes them as "different." Inevitable fatality of certain complex conditions in the past is now surgically avoidable. Pharmacologie advances include afterload reduction for severe congestive failure and various drugs (with or without pacemakers) that have improved the outcome for children who otherwise would not have survived. Unique problems for this new population include insurability, vocational choice, acceptable level of physical activity, sexual practices including contraception and childbearing, peer pressures, cardiac-related infections, coping with the possibility of death, and receipt of appropriate health and cardiac care.