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Pediatric cardiology is one of the oldest of the pediatric subspecialties. The last half of the 20th century showed a remarkable change in the focus of cardiologists from the treatment of acquired cardiac disease, like rheumatic fever, to the diagnosis and treatment of congenital heart defects of increasing complexity. Since the 1960s, each decade has brought new tools and medications to aid pediatric cardiologists in their care of children with heart disease. Arguably, one of the greatest tools, 2-dimensional and Doppler echocardiography, allows cardiologists to rapidly and accurately obtain vital anatomic and physiologic information noninvasively on patients of all ages. This tool was extended to prenatal diagnosis late in the 20th century. In the 1970s and 1980s, advances in surgical techniques and equipment that allowed surgery on small infants and children changed our management strategies for complex congenital heart disease from palliative to “corrective” therapies. Advances in cardiac catheterization and the birth of interventional cardiac procedures have allowed pediatric cardiologists the ability to offer nonsurgical options to many patients, where none existed before.

These remarkable therapeutic changes have resulted in several shifts of focus in pediatric cardiology. In clinical care, there is continued effort in determining the best management strategies for patients, including early diagnosis and the use of clinical guidelines. Importantly, the number of survivors with congenital heart disease of all types has grown exponentially, including patients with very complex disease who never lived to adulthood before the current era. This mandates that all primary care practitioners become well-versed in the wide range of diseases that now exist in the pediatric and young adult population. This book provides multiple chapters with information to allow primary care providers to become familiar with the tools used in the care of pediatric cardiology patients and the opportunity to review the different types of congenital heart defects in detail. Each chapter describes the cardiac anatomy and physiology, but also includes the management strategies that we use.

The management focus has also shifted from the postnatal diagnosis of congenital heart disease to prenatal diagnosis. This book provides a chapter for primary care physicians to become more familiar with the information gathered by fetal cardiologists from fetal echocardiography and how fetal diagnosis has impacted upon the care of patients and families with serious congenital heart disease. On the opposite end of the spectrum, the growing population of adults with congenital heart disease is an emerging and problematic issue. Here we face our greatest unknowns and challenges. Additionally, as this patient pool expands, it will mandate the need for more adult cardiac specialists with specific knowledge of congenital heart disease and the various management strategies that have allowed their survival. Currently, there are a relatively small number of adult specialists with this expertise, compared to the number of adult patients. This will prove to be a vital area of need in the future. This book provides a chapter that reviews some of these critical adult congenital heart issues.

In the current era, the likelihood that an infant with complex congenital heart disease will survive is very high. An area of growing research is how these children are doing from a neurocognitive perspective. It is not enough that a child survives heart surgery and goes to school. What is also important is how the child functions in the world with his or her peers. This is of critical importance to the family, and it is very important that primary care providers know what to be on the alert for, whether it be learning disabilities or other psychosocial issues that strain the child and family. This unique area is covered in a chapter that should be of interest to all readers.

Although congenital heart disease is a common form of birth defect in the general population, it is not the only type of heart problem approached in this book. The different forms of acquired inflammatory heart disease are reviewed here. Additionally, there is an important chapter that addresses the risk factors for acquired adult heart disease (atherosclerosis, hypertension, and obesity) during childhood. Given the epidemic of childhood obesity, this is a matter of high concern both to physicians and families, and this chapter should be of special interest to all primary care providers.

In the research realm, there is continued growth and interest in understanding the genetics and pathophysiology of the various congenital heart defects. This is a vast and complex area and cannot be reviewed in detail here. We have, however, included a chapter that reviews the current tools available to assess the genetics of congenital heart disease, as well as the forms of congenital heart disease that are associated with certain known syndromes. Perhaps in a different decade, the results of research efforts will allow us to intervene and either modify or alleviate some forms of congenital heart disease.

It is important to remember that the care of the pediatric heart patient is a joint effort between the subspecialist and the primary care practitioner. When physicians work with a shared knowledge base, then the care of the patient will be enhanced. It is our hope that this book will provide valuable information about all aspects of congenital and acquired heart disease to our colleagues in primary care medicine. It should also be helpful to medical students and pediatric or family practice residents in learning more about this important subspecialty. Whether you are a physician in the office, a nurse practitioner in a clinic, an emergency medicine physician, a dentist, or an obstetrician-gynecologist, there is no doubt that patients with congenital and acquired heart disease will cross your path. Given the variety of types of cardiac disease that exist, this can be an overwhelming concern. Our goal is that this book be an easy and reliable resource for obtaining up-to-date and accurate information as rapidly as possible. In that way, we can hope to ensure excellent care of these complex patients in the future.

Marie M. Gleason
Jack Rychik
Robert Shaddy

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