Complex Heart Defects of the Neonate: A Personal View

Abstract

I believe pediatric cardiologists and congenital heart surgeons must and do work hand-in-glove like no other medical/surgical specialists. Helen Brook Taussig and Alfred Blalock were an early testament to such a notion, albeit I understand Doctor Taussig didn't fully embrace the concept of reparative surgery for tetralogy of Fallot late in her career at Johns Hopkins University.

One evening in the late 1970s I walked through the ICU and there in the corner was a normal looking baby swaddled in a blanket. “Who is this,” I asked. “She's a cardiology patient. She's going to die, nothing can be done.” “Really, what's wrong?” “She has HLHS.” Well, believe it or not, I don't recall knowing anything about HLHS before that night. I quizzed my cardiology colleagues who knew more than I, but not a lot more. I'm not going to say much about HLHS surgery other than it flew in the face of a number of strongly held prejudices at the time and that surgery was necessarily performed in the neonatal period facilitated by DHCA.

Innovation is the life's blood of medicine. In 2008 I was invited to attend rounds at Children's Hospital of Boston and was asked whether I thought our earliest efforts with surgery for HLHS would be possible today. I answered, ''Probably not.'' This somewhat pessimistic view does not reflect a belief that the potential for physician-surgeon collaboration that is so essential to innovation is less now than it was in the era of Taussig and Blalock. Rather, it reflects the realities imposed today by a multi-layered bureaucracy of administrators and regulators who “manage” innovation under the watchful eye of trial lawyers.