Simple congenital heart disease: a complex challenge for public health

Congenital heart disease (CHD) represents a broad spectrum of conditions, from simple defects with an excellent prognosis, to the complex and severe, which require multiple procedures and have uncertain long-term outcomes. As outcomes in cardiac surgery have improved, research has tended to focus on more complex cardiac lesions, rather than mild defects where results were already excellent (1). Simple defects have been defined as ventricular septal defect (VSD), atrial septal defect (ASD), pulmonary stenosis (PS), patent ductus arteriosus (PDA), aortic stenosis (AS) and aortic coarctation in older children (2). In the case of many simple forms of CHD, survival has been said to be normal (3) and guidelines do not even recommend cardiology follow-up (4,5). Have these recommendations been made on sound evidence? Or has it simply become a truism that these patients have the same life expectancy as the general population?