Profiles in Congenital Heart Disease

In 1938 the first successful surgical management of a congenital heart lesion, a patent ductus arteriosus (PDA), was reported by Gross, and this was followed several years later by aortic coarctation surgical repair. During the subsequent two decades, intracardiac repair of atrial septal defect (ASD), ventricular septal defect (VSD), valvar pulmonary and aortic stenoses, and more complex lesions such as tetralogy of Fallot (TOF) became commonplace. Cardiac catheterization techniques developed in parallel with these advances, and, indeed, preoperative catheterizations preceded essentially all operations and helped considerably in improving surgical outcomes. In 1966, Rashkind and Miller introduced the first widely used catheter-based interventional technique, namely balloon atrial septostomy (BAS) for transposition. In 1982 Kan et al. described static balloon pulmonary valvotomy for pulmonary stenosis, which heralded the current surge of interventional procedures in the management of congenital heart diseases. From a pediatric perspective, now more than a half century after the pioneering report of Gross and together with the remarkable advances in ultrasound technology and surgery, most of the complex lesions, particularly in neonates and infants, are repaired surgically without catheterization. The catheterization laboratory patient population now consists primarily of those with residual lesions or simple unoperated lesions who come for interventional management.