Congenital heart surgery in a developing country: a few men for a great challenge.

The article by Larrazabal et al1 in this issue of Circulation can be analyzed from several points of view. The first is the humanitarian aspect involved in the decision of Dr Aldo Castañeda to return to Guatemala and start a program of congenital heart surgery. After so many contributions to congenital heart surgery as chair of the Department of Cardiovascular Surgery at the Children’s Hospital in Boston with all its available facilities, facing the difficulties of a country with tremendous social and economic problems was an example of persistence and idealism. It is also noteworthy that the recognized human and material support came from United States. Furthermore, the success of the project is measured by the increasing number of patients in each period studied, by the decrease in mortality, and especially by the training of personnel. This last aspect is well demonstrated in the case of the surgeons in that Dr Castañeda was progressively replaced in each surgical procedure. Finally, it is worth mentioning the methodology to validate the improvement in results with risk adjustment and comparison with US standards.