Introduction

Article Outline

 

I want to express my thanks to the more than 40 authors who contributed to the success of the Pediatric Cardiac Surgery Annual 2000 of the Seminars in Thoracic and Cardiovascular Surgery. They have devoted substantial time, effort, and their considerable expertise in examining specific topics of interest in congenital heart disease. I perceive that their insight is offered, not so much as the definitive statement on the art and science of cardiovascular care, but as a basis for further improvement in the future care for our patients.

The morphology of individual congenital cardiac defects invariably encompasses a broad spectrum of severity, and this spectrum influences our management strategies and the patient's outcome. The foremost example of a morphologic spectrum is double outlet right ventricle (DORV). DORV is not a diagnosis per se, but a relation of the right ventricle to the great arteries. The associated morphology determines whether the child is amenable to a simple or complex biventricular repair, or more appropriately managed by univentricular palliation. The symposium on DORV covers the morphologic and diagnostic features of this entity and describes the major surgical approaches to the management of these patients.

The section on clinical science contains a state of the art description of the current knowledge and future direction in understanding pulmonary vascular disease. Improvements in cardiopulmonary bypass techniques have allowed remarkable progress in the care of all our patients, especially the very young, and the history, science, and progress of cardiopulmonary bypass is examined in detail. Computerization is a vital part of our lives in this new century and it seems appropriate to have a discussion and blueprint for development of a congenital cardiac surgery database.

There are 7 chapters regarding specific clinical management issues of current interest. The Pediatric Cardiac Surgery Annual 2000 concludes with a section on long-term results after surgery, emphasizing the growing population of adults with congenital heart disease. The late problems of patients with transposition after an atrial switch are presented, and the current knowledge concerning late arterial switch conversion is discussed in comprehensive detail.

We have seen remarkable progress in the care of neonates, infants, children, and adults with congenital heart disease. Many areas of this progress are considered in the Pediatric Cardiac Surgery Annual 2000 in the hope of sustaining that progress.