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Amajor goal of the pediatric cardiologist is to help the infant born with congenital heart disease to become a productive adult. This goal has become realized in recent decades as, with successful medical and surgical management, over 85% of infants currently born with congenital heart disease can expect to survive to adulthood.' As we have all known for some time but has only recently become formalized, however, the outcome of care must extend beyond survival into issues of patient satisfaction, well-being, and productivity, as well as continued access to health care. It is in these areas that the growth of our care has not kept pace with the growth of our patients. In the recent Bethesda Conference on Adults with Congenital Heart Disease,2 one of the major concerns raised by the conference was the lack of financing for adults with congenital heart disease. For those of us who take care of these patients, it is difficult to explain the personal distress caused by the problem and the frustration felt by parents, patients, and physicians. I recently received a letter from a parent describing the growth of her child and her current situation, and she allowed me to submit it to Circulation. This letter was especially poignant to me personally in that her daughter was the first patient I cared for in the recovery room when I began my pediatric cardiology fellowship and one that I have followed closely ever since.

Health care policy for adults with congenital heart disease. The patient, the physician, and society.