With improvement in the survival of congenital heart disease (CHD) patients, anesthesiologists are encountering them with greater frequency as adults in noncardiac surgical settings. Depending on the underlying lesion, an adult with a history of CHD (ACHD) may have an uncorrected lesion or may have undergone a reparative or palliative procedure in the past. As the medical and surgical management of these conditions continues to evolve, different patients with the same original congenital defect may present having undergone significantly different procedures and, as a result, may differ in their anatomy and physiology. Transferring patient care to institutions with extensive experience in managing these disorders should be considered.