Over the past 50 years, paediatric cardiology has developed as a subspeciality of paediatrics linked to adult cardiology and cardiovascular (CV) surgery. It deals with diseases of the heart and the circulation in growing individuals and patients with congenital CV malformations and acquired CV disease (CVD) from foetal life to adolescent and adult age. Worldwide, 800 to 1,000 per 100,000 newborns are affected by a congenital CV malformation. One-third of these infants need hospitalisation and one or more cardiologic or surgical interventions directly after birth. An increasing number of all affected patients will need medical, catheter interventional or surgical treatments. Lifelong follow-up is necessary in a majority of these patients.
The incidence of acquired CVD in children and young adults is less well established and is subject to continuous change.
Over the past 50 years, and particularly during the last 20 years, diagnostic modalities and therapeutic options have shown revolutionary developments resulting in newer medical, interventional and surgical techniques with increasing survival rates. A continuous amelioration of the quality of life of these patients has been achieved. The modern treatment of congenital heart defects has led to normal or near normal adult life, even in several complicated defects that were previously fatal.
Paediatric cardiology problems will continue to persist but will change face due to prenatal interventions and early postnatal treatment.
Early interventions have created a new population of cardiac patients over the years. Even if the majority of the patients are doing well, new secondary and changing CV problems, and sometimes also general health problems, may evolve. They will require regular medical follow-up and several secondary CV interventions.
Genetics, embryology and morphology have, over many years, increased the knowledge of CV development and the inheritance of certain conditions. More recently, molecular biology has entered the field and is expected to promote revolutionary changes. Use of stem cell cultures is likely to become the ultimate solution for the treatment of heart diseases.
The paediatric cardiac population that will reach adulthood is progressively growing; thus, rather new challenges face the medical community – some of these situations will involve paediatric cardiologists but many more adult cardiologists and CV surgeons. The relative unfamiliarity of the medical community with these late-appearing problems pushes towards the development of new concepts. The medical society and industry of several fields is requested to come together and to solve these new challenges. Continuous medical education is required to maintain quality and safety and to create new means of treatment.