Foreword to the Second Edition

The Big Heart Disease Lie

How I Healed my Cardiovascular Disease

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This second edition of the masterful Surgery for Congenital Heart Defects is a worthy successor to the first edition of that great work, which appeared in 1983. Drs Stark and de Leval have designated themselves 'editors,' but in fact they clearly are both the stimuli for the second edition and the main contributors to it. In fact, this important book could be considered a detailed summary of all aspects of the experience of their prestigious unit, The Hospital for Sick Children at Great Ormond Street, London, with congenital cardiac disease over a period of at least 40 years. This alone recommends this text to all serious students and practitioners of the art and science of managing patients with these conditions. The fact that the book describes far more than simply operations and their results emphasizes the multidisciplinary nature of all serious endeavors in this area; good surgery alone can no longer suffice as evidence of institutional expertise in the area of congenital cardiac disease.

The book is clearly more broadly based than it would be had it been written only by the staff at the Great Ormond Street hospital. In a sense it could be considered a contribution of London, England, to the expanding knowledge of all aspects of congenital heart disease; the major contributions from this area over a period of many years also make the text invaluable. In addition, however, Drs Stark and de Leval have selectively tapped the resources of the rest of the medical world in developing this superb text.

This book becomes available at a particularly important and probably pivotal time in the area of congenital heart disease. In some parts of the world, there now exists the capability of eliminating congenital heart disease from the population, using prenatal echocardiographic diagnosis and abortion of an affected fetus. Ironically, this comes at a time when the results of many types of interventions for congenital cardiac disease are outstandingly good. For some types of congenital heart disease, literal cures by surgery have been documented. In contrast, it is now known that some conditions (for example, coarctation of the aorta) that seemed to be cured by intervention are only palliated, but this palliation may last for 50 years or more. Certain congenital cardiac anomalies that only a few years ago were essentially untreatable, such as interrupted aortic arch and aortic atresia, now can be at least extremely well palliated by one of several methods, and this palliation can be expected to last for a number of years even though not for the usual lifetime of a normal individual. In view of the diversity in the time-related quality of the outcomes, the variety of the interventions available for various types of congenital heart disease, and the many decisions that currently must be made in managing patients with congenital heart disease, it now becomes essential to quantify and compare outcomes. Also, it may become necessary somehow to pick and choose between institutions because of the growing suspicion that a concentration of relatively large numbers of such patients in relatively few institutions may improve outcomes. This again should involve quantification of outcomes, sophisticated methods of analyses, and factual (rather than simply political) comparisons of institutions and physicians.

Were this not enough to justify the extensive material presented in this text, society in general has added quality of care, appropriateness of care, effectiveness of care, and cost of care to its jargon of qualifications to be met by all of us in our hospital wards, laboratories, operating rooms, and intensive care units. It is this, plus the alleged imperfections in the outcomes we obtain and their high costs, along with the changing lifestyles and philosophies of our times and the strong emotions that accompany all discussions of health care (let alone those of abortion, nonuseful extension of life, and physician-assisted death), that makes so necessary the gathering together of the varied and extensive information presented in this second edition of Surgery for Congenital Heart Defects.

I look forward to detailed study of each of the wonderful chapters that have been presented in this book. Indeed, I recommend such study to everyone involved with decisions and management for that part of our populations afflicted with congenital heart disease.

JOHN W. KIRKLIN, MD

Division of Cardiothoracic Surgery University of Alabama at Birmingham Birmingham, Alabama, USA

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