Over the past decade, the focus of the pediatric catheterization laboratory has changed dramatically from its primary diagnostic function to a conduit for therapeutics. Although the first application of such catheter interventions was described more than 44 years ago by Rubio-Alvarez and Limon-Larson,<sup>145 Rubio-Alvarez V, Limon-Larson R: Treatment of pulmonary valvular stenosis and tricuspid stenosis with a modified cardiac catheter. In Program Abstract II, Second World Congress on Cardiology, Washington, DC, 1954, p 205

Cliccare qui per andare alla sezione Riferimenti</sup> not until 1966, when Rashkind and Miller<sup>132 Rashkind W.J., Miller W.W. Creation of an atrial septal defect without thoracotomy JAMA 1966 ;  196 : 991

Cliccare qui per andare alla sezione Riferimenti</sup> described the technique for percutaneous creation of an atrial septal defect in the setting of complete transposition of the great arteries, did such catheter maneuvers decisively affect patient management.<sup>82 Lock J.E., Keane J.F., Fellows K.E. The use of catheter intervention procedures for congenital heart disease J Am Coll Cardiol 1986 ;  7 : 1420

Cliccare qui per andare alla sezione Riferimenti, 134 Rashkind W.J. A glance forward: Closure of cardiac defects without surgery Heart Disease in Infants and Children London: Edward Arnold Ltd. (1980).  249

Cliccare qui per andare alla sezione Riferimenti, 135 Rashkind W.J. Transcatheter treatment of congenital heart disease Circulation 1983 ;  67 : 711  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 136 Rashkind W.J., Gibson J. Interventional cardiac catheterization in congenital heart disease Int J Cardiol 1985 ;  7 : 1

Cliccare qui per andare alla sezione Riferimenti</sup> Today, therapeutic catheterization techniques have replaced conventional surgery for many lesions. New methods, tested through research protocols in specialized centers, combined with continuous critical evaluation of established techniques, continue to ensure improved and sustained results. The primary consideration of practicing pediatric cardiologists should not be whether such techniques are possible to perform, but whether their clinical utility, morbidity, and mortality justify a nonsurgical approach for patients. Unsuccessful outcomes, including complications and nondefinitive outcomes, may in part yield to experience and improvements in technique.

Therapeutic interventions, such as cardiac surgery, have three principal objectives: (1) improvement or preservation of cardiac function, (2) improvement in longevity, and (3) maintenance or improvement in the quality of life (QOL). Catheterization interventions may be corrective, reparative, or palliative. Catheter therapies may also be applied as adjuncts to surgery. Cooperation has developed between pediatric cardiologists and pediatric cardiac surgeons in planning staged repairs of complex congenital heart disease (CHD). This type of cooperation will increase and is already contributing to far better outcomes for many complex congenital heart lesions.