Congenital heart disease (CHD) presents medical management challenges throughout the lifespan. As the complexity of the lesion increases, so do the management challenges. These issues include medication use; short-term postoperative management monitoring of growth, nutrition, development, family impact, immunization; and long-term management issues. The knowledge base in this field is ever growing, and only with knowing what to expect can we identify the unexpected and make that part of our understanding of the care of children with CHD.