The Evolution and Future of Pediatric Cardiology

From early descriptions of heart disease to its current interdisciplinary practice of antenatal diagnosis of heart defects, advanced imaging, interventional catheterization, cardiac surgery, electrophysiology, pediatric intensive care, pediatric heart transplantation, and lifelong follow-up of patients with congenital heart defects, pediatric cardiology has undergone significant changes and developments in the past centuries. This review aims to outline these developments in pediatric cardiology and attempts to predict the forces that will shape its future. Innovations to measure the hidden physiological processes of the circulation of blood, such as the stethoscope, the electrocardiogram, cardiac catheterization, and most importantly, the echocardiogram, have greatly contributed to the field of pediatric cardiology. The 20th century introduced the innovations of cardiopulmonary bypass and congenital heart surgery, followed by interventional catheterization, the use of prostaglandin E1 to support the circulation in neonates with duct-dependent heart defects, pediatric heart transplantation, and mechanical circulatory support. In the modern era of pediatric cardiology, high-quality images of cardiac structure and function are obtained by the use of cardiac magnetic resonance imaging and multidetector row computed tomography. There is also an increasing number of patients diagnosed with heart defects prenatally, which has led to the establishment of antenatal cardiology as a separate field of interest. Furthermore, pediatric cardiology has greatly benefited from the advances made in the genetic basis of inherited arrhythmias and cardiomyopathies. Also, quality improvement collaboratives have provided a structured environment for process improvement. An important area that pediatric cardiology is currently focusing on is the transition of care to adult congenital heart disease programs. The challenge of pediatric cardiology is not only to identify the cardiac anatomy of patients' heart defects but also to predict the clinical course of the defects, the causes of the defects, and the morbidity of the defects after surgical repair, and to provide durable care for children with heart disease throughout their childhood and into their adulthood. The future of pediatric cardiology will include the use of genomics for risk stratification of at-risk individuals and patients with heart disease, pharmacologic therapy that is matched to specific pathways, regenerative medicine and cardiac tissue engineering, the development of smaller and more durable mechanical circulatory support devices, the development and use of computational models and digital clinical twins, and the use of artificial intelligence for imaging and monitoring of patients with heart disease. Pediatric cardiology must also evolve to become a system of care that includes neurodevelopmental, psychosocial, and transition of care outcomes in addition to the current measurement, interpretation, and intervention of heart disease in children and adults with congenital heart disease.