Forty years of cardiac disease in children. Progress and problems--first of three parts.

We review the major advances that have occurred in the diagnosis and treatment of cardiac diseases in children during the last four decades. During this period, most forms of congenital heart disease have become treatable by operation, and diagnosis has become possible through echocardiography alone. Operative mortality has dropped, and long-term follow-up shows excellent results in most patients. The incidence of rheumatic fever has declined, although it has increased recently in several areas of the United States. The occurrence of infective endocarditis and of myopericarditis has remained stable, while the recently described Kawasaki disease can affect the coronary arteries in children and appears to represent a new condition.