From January 1972 to April 1982, 125 adults underwent operation for congenital heart disease at the Medical University of South Carolina. Age ranged from 18 to 73 years, with an average age of 31 years. A variety of defects were seen. Atrial septal defect (59 patients), ventricular septal defect (15 patients), patent ductus arteriosus (14 patients), tetralogy of Fallot (14 patients), and coarctation of the aorta (9 patients) were the most common. There were 48 men and 77 women in the study. Most patients presented with recent onset of dyspnea on exertion or at rest, but 16 patients were asymptomatic. Eight patients died after surgery for an overall operative mortality rate of 6 per cent. The most common postoperative complication was arrhythmia (13 patients, 10%). Despite recent advances in the diagnosis and treatment of congenital heart disease in infants, a significant number of patients apparently escape detection and first present with congenital heart disease as adults. Prompt diagnosis and surgical intervention will usually produce excellent results and relief of symptoms in these patients.