Paediatric & adult congenital

Congenital Heart Disease in medico-legal claims

Expert witness reports on missed or delayed diagnosis of congenital heart defects in paediatrics, and suboptimal management of adult congenital heart disease (ACHD).

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  • Missed congenital heart defect
  • Adult congenital heart disease
  • Paediatric cardiology
  • Bolam · Bolitho · Montgomery
what we cover

The congenital defect and the legal questions it raises.

Congenital heart disease covers structural defects present at birth and their lifelong sequelae, requiring specialist paediatric and adult congenital cardiology input. Timely diagnosis and intervention are critical to prevent irreversible cardiac dysfunction, arrhythmia or sudden death.

Most instructions arise where antenatal screening, neonatal examination or paediatric assessment failed to detect a defect, or where adult congenital heart disease (ACHD) management fell below expected standards. The decisions are tested against current RCPCH paediatric cardiology guidance, the ESC guidelines on adult congenital heart disease, and NHS England’s ACHD commissioning policy.

  • Breach questions address antenatal ultrasound findings, neonatal murmur assessment, pulse oximetry screening and the threshold for echocardiography referral.
  • Causation questions turn on whether earlier diagnosis would have led to surgical or catheter-based intervention, and whether that would, on the balance of probabilities, have prevented arrhythmia, heart failure or sudden death.
  • ACHD management — transition from paediatric to adult services, surveillance imaging, and arrhythmia risk stratification — is frequently in scope for claims involving missed follow-up.
  • Inquests may require expert evidence on whether the defect contributed to a death and whether earlier intervention would have altered the outcome.
Clinical scope

The clinical questions our cardiologists answer.

Reports address the paediatric and adult congenital cardiology decisions in issue against current guidance and the Bolam and Bolitho standard.

Included in scope

Questions addressed

  • Whether antenatal ultrasound findings were consistent with a detectable congenital heart defect, and whether the differential diagnosis included structural cardiac anomalies.
  • Whether neonatal murmur assessment, pulse oximetry screening and echocardiography referral followed RCPCH and NHS England guidance.
  • Whether ACHD surveillance imaging, arrhythmia risk stratification and specialist follow-up met the ESC adult congenital heart disease guidance.
  • Whether, on the balance of probabilities, earlier diagnosis or intervention would have altered the clinical outcome, with material contribution analysis where appropriate.
  • Whether the transition from paediatric to adult congenital cardiology services was managed in accordance with NHS England’s ACHD commissioning policy.
Out of scope

Not covered without separate instruction

  • Interventional or surgical technique during catheter-based or open-heart repair of congenital defects, which sits with interventional cardiology or cardiac surgery instruction.
  • Examination of the claimant or prognosis evaluation, which requires a separate condition and prognosis report.
  • Quantum, life expectancy and care needs, addressed through dedicated reports where the case progresses to that stage.
  • Genetic counselling or prenatal diagnosis decisions, which require separate instruction from a clinical genetics expert.
Common cases

Common scenarios we report on.

These patterns recur in congenital heart disease claims, most turning on antenatal screening, neonatal assessment or adult follow-up.

  • Antenatal · Screening

    Missed congenital heart defect on antenatal ultrasound

    The four-chamber view and outflow tract assessment failed to detect a ventricular septal defect or tetralogy of Fallot. The report addresses whether the ultrasound findings met the accepted standard for antenatal cardiac screening and whether earlier detection would have altered management.

    Often paired with: Breach of Duty Causation

  • Neonatal · Examination

    Neonatal murmur not referred for echocardiography

    A persistent murmur was detected on newborn examination but not referred for echocardiography. Coarctation of the aorta or atrial septal defect was later diagnosed after collapse. The report examines whether the referral threshold was met under RCPCH guidance.

    Often paired with: Breach of Duty Causation

  • ACHD · Follow-up

    Missed ACHD follow-up leading to heart failure

    Adult with repaired congenital heart disease was lost to follow-up and presented with decompensated heart failure. The report addresses whether the ESC ACHD surveillance guidance was followed and whether earlier intervention would have prevented deterioration.

    Often paired with: Screening & Merits Breach of Duty

  • Transition · Paediatric to adult

    Failed transition from paediatric to adult congenital cardiology

    Adolescent with congenital heart disease was discharged from paediatric services but not transitioned to adult congenital cardiology. Arrhythmia or sudden death followed. The report tests whether NHS England’s ACHD commissioning policy on transition was adhered to.

    Often paired with: Causation Condition & Prognosis

Reports

Report types commissioned for this condition.

These cases typically progress from screening into full liability work, with causation often the central battleground. ACHD claims may also require inquest reports where the death occurred in adulthood.

Approaching a deadline?

Instruct an expert in congenital heart disease.

Send a short note on the alleged failings with the records bundle, and we will match the right paediatric or adult congenital cardiologist. Quotation returned the same working day; fast-track available where the trial window or limitation deadline requires it.

Instruct a cardiology expert Call 0800 161 3395

GMC-registered consultants Fixed fee where the bundle allows LAA rates available