The Numbers Game, or Is Small Beautiful?

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Abstract
During the past 20 years, innovative surgical and medical techniques have been applied to a variety of congenital cardiac defects. Among these techniques are the Mustard operation1 and the Jatene operation switching the pulmonary artery and aorta2 for complete transposition of the great arteries; the Rastelli outflow patch and right ventricular conduit3; the Fontan procedure for tricuspid atresia4; and the balloon septostomy of Rashkind.5 Such procedures have dramatically altered the prospects of survival for many children born with cardiac defects, and in so doing they are creating a totally different profile of congenital cardiovascular disease.6 In 1976 an . . .