A change of heart: the evolution of care for children with Trisomy 21 and CHD.

Trisomy 21 is the most common chromosomal anomaly worldwide, and nearly half of the affected individuals are born with CHD, making cardiac complications a leading cause of morbidity and mortality in this population. Over the past century, the management of CHD in patients with Trisomy 21 has evolved dramatically, shaped by shifting societal attitudes, advances in diagnostic and surgical techniques, and landmark legal and ethical milestones. Historically, children with Trisomy 21 faced significant barriers to cardiac care, including delayed referrals and denial of surgical intervention, often rooted in discrimination rather than medical evidence. However, improvements in perioperative management and early surgical repair have led to survival outcomes for many forms of CHD that now approach those of the general population. Despite these advances, challenges persist, particularly in access to heart transplantation, where disparities in referral and eligibility remain. This review provides a historical overview of the evolution of CHD management in individuals with Trisomy 21, highlighting key medical, ethical, and societal developments that have shaped current standards of care.