Neurodevelopmental outcome in children with congenital heart disease: a work in progress.

Abstract

When I began my residency in 1977, treatment of children with congenital heart defects was evolving in the context of an inspiring collaboration between pediatric cardiology, cardiac surgery, and cardiac anesthesia. In the ensuing decades, thousands of infants were saved by novel imaging, new operations, and refined supportive methods. The impact on these children was, in many instances, not only lifesaving but even miraculous. A similar phenomenon was occurring nationally and internationally, and advances in diagnosis, treatment, surgical interventions, and support techniques changed faster than in perhaps any other pediatric field. By the mid-1980s, many previously fatal congenital cardiac lesions had become operable, and survival rates had improved. In addition, new surgical techniques were developed to repair even the most complex lesions during early infancy rather than in 2 stages (ie, first palliative, then later reparative surgery), and morbidity and mortality declined. Dazzling progress in the sophistication of surgical repair is illustrated nowhere better than by the transition of surgery for dextrotransposition of the great arteries from atrial switch surgery (eg, … Address correspondence to Leonard Rappaport, MD, MS, Boston Children’s Hospital, Fegan 10, 300 Longwood Avenue, Boston, MA 02115. E-mail: leonard.rappaport{at}childrens.harvard.edu