Introduction

Although considerable effort has been invested in the development of screening programmes to detect congenital heart disease before and after birth, a large proportion of infants with congenital heart defects remain undetected by these programmes and come to the attention of the medical profession only after they develop symptoms.¹ These symptomatic infants can present in extremis and die rapidly. A study of 1590 babies with congenital heart disease who presented in the northern region of the United Kingdom was published in this journal in 1999: one in 10 presented with cardiac symptoms before the first neonatal screening examination and more than half were considered to have a normal cardiovascular system at this examination.¹ Of these, almost 40% presented with symptoms or died before the routine 6 week check. These observations are consistent with data from abroad, including the large Baltimore-Washington Study, in which it was observed that, of all infants with cardiovascular malformations . . . [Full text of this article]