Editorial: What Does the Pediatrician Needs to Know About Heart Defects in Children?

Since the early descriptions of a) clinical and simple laboratory features of congenital heart defects (CHDs) by Taussig, Keith, Rowe and Vlad, Gasul and Arcilla, Wood and Nadas and their associates in their respective text books, b) closed heart surgery to ligate the patent ductus arteriosus (PDA) by Gross and Hubbard (1938), repair of coarctation of the aorta by Crawfoord and Nylin and Gross (1945), aorto-pulmonary shunt by Blalock and Taussig (1945), closed pulmonary valvotomy by Brock (1946) and pulmonary artery banding by Muller and Damman (1952), c) open-heart surgery by Bigelow and Lindsey (1950), Lewis and Tauffic (1953) and Gibbon, Lillehei and Kirklin (1953 to 1955) and their associates, and d) transcatheter techniques to address CHD by pulmonary and tricuspid valvotomy by Rubio Alverez and Limon-Lason (1953), balloon atrial septostomy by Rashkind and Miller (1966), occlusion of PDA by Portsmann (1967), closure of atrial septal defects by King and Mills (1974) and Rashkind (1775) and their associates, colossal developments in noninvasive diagnostic techniques (Echocardiograhic and Doppler studies, magnetic resonance imaging and computed tomography scan), timely recognition of the neonates with serious CHD, rapid transportation of the identified babies to tertiary care facilities, progress in neonatal care and anesthesia, advances in understanding of and availability of newer drugs, progress in intensive care management, improvements in transcatheter interventional techniques and expansion of complicated surgical procedures to the neonate and young infant have improved to such an extent that most, if not all, CHDs can be accurately diagnosed and Bcorrected^. The defects that could not be corrected are palliated in an effective manner. While these are remarkable achievements, their utility may not be achieved to the maximum amount unless these infants and children are identified by physicians who care for children (neonatologists, pediatricians, general/family practitioners). The current Pediatric Cardiology Symposia intend to lay out information useful for these physicians so that they can identify these babies and children and provide guidelines as to when to refer them for appropriate intervention. In the first paper of this Symposium, Dr. Krishna Kumar of Amrita Institute of Medical Sciences of Kochi, India discusses evaluation of congenital obstructive cardiac lesions [1]. In the second paper, Dr. I.B. Vijayalakshmi of Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India reviews evaluation of left-to-right shunts [2]. In the next two papers, Dr. Anita Saxena of All India Institute of Medical Sciences, New Delhi, India focuses on evaluation of acquired valvular heart disease (rheumatic heart disease) [3, 4], particularly common in the Indian subcontinent. The authors describe the relative prevalence of these disease entities, clinical and simple laboratory features and utility of echocardiographic studies in the diagnosis and quantification of the degree of severity. They also attempt to address the question of when is the best time to refer these patients for intervention. They also specify the usefulness of catheter interventional techniques that are helpful in managing these disease entities as well as surgical intervention as appropriate. In the final paper of Part I of this Symposium, Dr. Saurabh Gupta, also of All India Institute of Medical Sciences, New Delhi, India talks about diagnostic approach to a neonate with cyanosis [5]. An orderly, methodical and stepwise approach of evaluation of clinical, electrocardiographic and chest x-ray findings is presented with particular emphasis on categorizing * P. Syamasundar Rao p.syamasundar.rao@uth.tmc.edu