Pediatric cardiac surgery: the long view.

C ongenital heart defects are the most common birth defects. Many of them are associated with substantial morbidity and mortality. Of all congenital conditions, heart defects account for the highest resource utilization among pediatric hospitalizations in developed countries. 1 The history of cardiac surgery now spans nearly 8 decades. In the earliest era of cardiac surgery, operations on children and young adults with congenital cardiac malforma-tions accounted for the lion's share of " heart operations. " Closure of patent ductus by Strieder and by Gross in Boston, MA (1937, 1938), repair of coarctation of the aorta by Craaford in Stockholm, Sweden (1944), and the " blue baby " shunt procedure by Blalock in Baltimore, MD (1944) were landmark achievements that signaled the birth of the medical and surgical subspecialties of pediatric cardiology and congenital heart surgery. What followed was a period of 7 decades marked by huge increases in the understanding of circulatory physiology and the abnormal morphology and functional consequences of structural congenital heart disease; burgeoning technology that may facilitate earlier, more precise, and more complete characterization of abnormally formed hearts; and therapeutic innovations that may save and prolong lives and ultimately contribute to the mission of maximizing longevity and optimizing the quality of life of individuals living with congenital heart disease. By the 1970s, primary repair of complex forms of congenital heart disease in neonates and young infants was becoming a more widely acknowledged reality. By the mid-1980s, virtually all common congenital cardiac anomalies had been moved to the " treatable " column on the tables expressing severity. The rapid progress in surgical therapy was just one element of a bigger picture that also encompassed the application of less invasive and more informative diagnostic modalities, the emergence of pedi-atric cardiac critical care, and the evolution of a true multidisciplinary approach to management of congenital heart disease, increasingly informed by advances in cell biology, pharmacology, and other basic sciences. By the beginning of the 21st century, contemporary estimates suggested that 85% of patients born with congenital heart disease in the United States would survive into adult life. 2 By 2010, researchers reported that approximately 2 million infants, children , adolescents, and adults were living with congenital heart disease in the United States and that for the first time, the number of adults in the United States living with congenital heart disease was as large as the number of children …