Historical Perspectives

Abstract

The frequency of congenital diseases of the heart is generally quoted as about 8 per 1,000 live births. However, this estimate was based on autopsy or clinical assessments prior to the era of cardiac ultrasonography. It is now appreciated that many infants are born with ventricular septal defects that close soon after birth, that the aortic valve is bicuspid in 1% to 2% of individuals, and that a small “silent” patent ductus arteriosus may be detected by ultrasonography in as many as 0.3% to 0.5% of infants. Persistent patency of the ductus arteriosus in a large proportion of preterm infants also has been recognized. Thus, the frequency of congenital cardiac lesions may be as high as 4% to 5%. In Sir James Mackenzie’s book Diseases of the Heart in 1913, the chapter on Congenital Affections of the Heart occupied one page; in the section on Treatment, he stated, “If the heart maintains the circulation well, no treatment is required. In more serious cases, beyond attending to the child’s comfort and nourishment, special treatment of the heart is of little benefit… .” Now, about 90 years later, the majority of those lesions that do not improve spontaneously can be corrected or palliated. Lord Ritchie-Calder stated that, “In science, there are those that make it happen, and those that make it possible.” This discussion reviews some remarkable achievements and the individuals who made them possible or were responsible for their execution. Case reports of several congenital cardiac lesions had been reported earlier, such as ventricular septal defect (maladie de Roger) and tetralogy of Fallot, but in the late 19th and early 20th century, Maude Abbott (Fig. 1), through intensive study of pathologic specimens, described the various types of congenital defects of the heart and developed a classification. Figure 1. Maude Abbott. Courtesy of the …