The new guidelines of the European Society of Cardiology (ESC) for the management of grown-up congenital heart disease were published in August 2010 and follow the first guidelines on this subject published by the society in 2003. This article discusses the rational for publishing this document and the difficulties of generating guidelines for this special field in cardiology. The concept of the new document is outlined and differences when compared with the previous version are summarized. In addition, the European guideline document is compared with the current guidelines of the American Heart Association and the American College of Cardiology. Compared to previous documents the new guidelines provide more comprehensive information with more precise recommendations and update the knowledge in this field. They should help to improve the quality of care of grown-up congenital heart disease patients.