Twenty-five years of progress in the medical treatment of pediatric and congenital heart disease

In the past 25 years there has been a many-fold increase in the prospect that with early recognition and modern treatment the newborn with critical congenital heart disease will reach adult life in a healthy condition, prepared to earn a living and to function as a spouse and as a parent. Advancements in the medical treatment of congenital heart disease may create less public acclaim than may surgical treatment but many purely medical developments provide the basis for achieving ultimate surgical success and, by judicious use of some forms of medical treatment, operation can be avoided altogether. The eight major contributions to patient care that are discussed in this review and the 35 that are simply listed are merely examples of the many developments that have occurred in the past 25 years. These include: 1) the organization of pediatric cardiology and the contribution of volunteer health organizations, 2) continuing medical education aimed at promoting early diagnosis of congenital heart disease and prompt referral to a cardiac center, 3) advances in the technology of cardiac catheterization, 4) Rashkind's balloon atrial septostomy and other catheter manipulative procedures, 5) pharmacologic manipulation of the ductus, 6) beta-adrenergic blockade for control of a variety of problems, including paroxysmal hypoxemic attacks, certain arrhythmias and relief of symptoms in hypertrophic cardiomyopathy, 7) echocardiography, and 8) advances in arrhythmias, electrophysiologic studies and use of pacemakers.