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“There is nothing more difficult to take in hand, more perilous to conduct, nor uncertain in its success, than to take the lead in the introduction of a new order of things. For the innovator has for enemies all of those who have done well under the old, and lukewarm defenders in all of those who may do well under the new.”

—Niccoló Macchiavelli (1469–1527)

Few other medical disciplines have required for their development the degree of daring courage, tenacity, and drive that characterized the efforts of the early pioneers in the field of congenital cardiac surgery. Only a century ago, Theodore Billroth publicly condemned the dream of cardiac surgical intervention by stating that “Any surgeon who wishes to preserve the respect of his colleagues would never attempt to operate on the heart.”1 Over the past six decades, the specialty of pediatric cardiac surgery has evolved from a heroic effort with occasional success into a consolidated, sophisticated specialty with excellent outcomes and, essentially, few limits imposed by pathology or age of the patient.

The history of pediatric heart surgery initially coincided with that of cardiac surgery itself. By far, the majority of early extra- and intracardiac procedures were in fact performed to address various forms of congenital (rather than acquired) heart disease. The adventure of intracardiac repair of congenital malformations, in turn, paved the way for technical advancements that pushed forward the field of adult cardiac surgery.

Each of the chapters in Part III of this book briefly touches on the historical highlights that pertain to specific malformations. In this chapter, the reader is offered a broad overview and key historical references that pertain to the initial evolution of this challenging field (Table 58-1), identifying four successive eras: (1) that of closed extracardiac operations; (2) the era of early closed or semiclosed intracardiac operations; (3) the initial phase of complete intracardiac repair; and (4) a subsequent period marked by the refinement of techniques and the expansion of the field to the correction or palliation of virtually any type of congenital heart disease.

Table 58-1:The Evolution of Cardiac Surgery: Time Linea

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