Congenital heart disease: six decades of progress.

Congenital heart malformations occur in approximately 1 in 100 live births. Since Robert Gross successfully ligated a persistent ductus arteriosus 60 years ago, there has been enormous progress in the surgical management of even the most complex lesions. More recently, the interventional cardiologist armed with balloons, stents, coils, umbrellas, and laser beams is providing an alternative to surgery for many lesions. Echocardiography combined with Doppler studies is now the most informative diagnostic modality, and its usefulness is being expanded by transesophageal studies. Magnetic resonance imaging is helpful for some lesions not well visualized on echo. Some complex lesions continue to challenge caregivers, especially the hypoplastic left heart syndrome and several variants of pulmonary atresia. Neurological complications in patients with congenital heart disease are not uncommon and are the main theme of this issue.