INFORMATION on the "natural history" of congenital cardiac malformations is difficult to obtain and may have very little meaning for the statistician. One is aware that the facts obtained may yield a profile only of those patients with heart malformations who have signs and symptoms significant enough to bring them to a cardiac center. The others, either not sick enough to come to a center, or too sick and even dying before they can be brought to the specialist, or living too far from the medical center, therefore, will not be included in any survey. The only way the entire congenital heart disease population may be caught in the net of the investigator is by following up carefully a large group of newborns.
Though information gathered may not be statistically significant it is none the less important as a frame of reference in making recommendations to patients and their families. Also it is of necessary historical import that we document the course of patients with malformations as yet unaltered by the hand of the surgeons. The effect of surgery on patients with certain malformations is far reaching and changes the course of their natural history. Another reason why we should try to find out what happens without operation to certain patients is that there will be a tremendous advance in cardiovascular surgical techniques for many lesions yet in the future. Nobody questions the fact that cardiac surgery, in many, if not most, areas will be better tomorrow than it is today.
The notable exceptions to improvement of surgical techniques include repair of patent ductus arteriosus, coarctation of the aorta, secundum atrial septal defect, and pulmonic stenosis.
Natural History of Ruptured Cerebral Aneurysms: Overall Result of Subarachnoid Hemorrhage in an Emergency Medical Center