Paediatric cardiology: Looking back, looking forward

With the publication of Maude Abbott's Atlas of Congenital Cardiac Disease in 1936, the field of paediatric cardiology was born in Canada, but in those early days, it was understandably confined to the description and taxonomy of heart defects in the young. Since that time, the reliable palliation and repair of increasingly complex cardiac conditions has become commonplace, and simple survival is no longer the only goal; with the increasing number of survivors, there is an increasing need to ensure long-term quality of life. Coinciding with these changes has been the growing realization that children born with healthy hearts are in danger of acquiring cardiovascular risk factors that were found exclusively in adults in past generations. There are children and youth with heart disease, and at risk of heart disease, in every paediatric and primary care practice in Canada. With these thoughts in mind, we welcome you to the Cardiology focus issue of Paediatrics & Child Health. You will not find articles on classification, reviews of surgical procedures or images of the latest catheter technologies in the present issue. Instead, we have gathered manuscripts that cover a variety of topics of interest to child and youth health care providers, including a collaborative approach to diagnosis, current outcomes for complex patients and thought-provoking controversies in management and prevention strategies. The realities of our country's geography (and our profession's numbers) have necessitated innovative means of communication and collaboration to bring diagnostic expertise to patients with suspected heart disease, wherever they may be. In the first article, Dr John Finley gives us an introduction to a Canadian success story – the Maritime telecardiology program (pages 156–158). The earlier diagnosis and institution of treatment that this program offers is one of many ways that paediatricians can positively influence outcomes in complex congenital heart disease, especially for those in rural areas. Earlier diagnosis is one reason that patient outcomes have improved; other reasons include ever-evolving techniques of catheter intervention, cardiac surgery and the associated pre- and postoperative care. We counsel families not only on the short-term expectations of these procedures, but also need to address families' questions and uncertainties that extend well beyond the first catheterization, the first surgery and the first outpatient visit. Dr Derek Human provides a comprehensive update on current outcomes for these patients, providing answers for paediatricians for families' questions not only about life expectancy, but also about the quality of that life (pages 161–166). As the survival rate increases, new fields of enquiry emerge, such as the effects of physical activity on children with heart disease. This is a subject that prompts questions from parents, schools and patients themselves. Moola et al (pages 167–170) explains the demonstrated benefits for the majority, the occasions when restrictions are appropriate and the need for further exploration of this rapidly changing area of medicine. Children with congenital heart disease will experience a number of firsts that parallel those of their nonaffected peers: first steps, first words, first teeth and a first visit to the dentist. The recent change in antibiotic prophylaxis for dental procedures has come under scrutiny and has given rise to new questions and debates, perhaps more in terms of the philosophy underlying the change, rather than the pragmatics of its application. The point-counterpoint provided by Drs Marie Béland (pages 171–172) and Roland Beaulieu (pages 173–175) provides differing viewpoints on this topic. In addition to dealing with the increasing frequency and complexity of congenital heart disease patients in paediatric practice, child and youth health practitioners are now being faced with the challenges of the rising epidemic of obesity and the secondary complications that ensue. Diseases once considered to be adult-onset are now being diagnosed in children, introducing a whole new era in the practice of paediatric medicine. Dr Tracey Bridger's overview (pages 177–182) provides paediatricians with practical information to guide investigation, management and prevention of these complications. The sudden death of a young person, particularly one without a history of known heart disease, is a tragedy on multiple levels, and seizes both media and medical attention. These apparently healthy young people, who may have undiagnosed cardiomyopathies, conduction defects or other conditions, have no idea that they are at risk. Limited resources lead to debate about the most effective methods of prevention and intervention; Drs Stuart Berger (pages 183–184) and Robert Gow (pages 185–188) reflect on two possible approaches to saving lives. We trust that you, the reader, will find the articles informative, thought-provoking and will join us in thanking the authors, reviewers and staff at Paediatrics & Child Health for their hard work on the present issue. We hope that the diversity of topics discussed will make this theme issue a continuing reference for all.

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