To the Editor:

It was with great interest that I read “Proposed Analysis of the Transition Process from Pediatric to Adult Care for Patients with Congenital Heart disease in Israel” (Burke and Beeber). As a pediatric cardiologist in practice for more than 20 years, I have many adolescent patients with congenital heart disease (CHD) who are nearing adulthood and the necessary transition of care.The authors correctly point out the transition and subsequent care during adulthood are exceedingly important. Historically, a major problem has been that pediatric cardiologists, while expert in management of CHD, are not experienced in managing the other medical conditions that arise during adulthood. Conversely, adult cardiologists, while very familiar with adult ailments, have little experience with CHD.

It is for that reason that the relatively new field of adult congenital heart disease has emerged, in which cardiologists trained to care for for adults undergo additional special training (typically 2 years in the United States) in congenital heart disease. While this is important for all patients with CHD, it is most important for those individuals with more complex forms of CHD. This includes single ventricle lesions (including hypoplastic left heart syndrome and tricuspid atresia), pulmonary atresia, tetralogy of Fallot, transposition of the great vessels, and endocardial cushion defects, all of which can have significant sequela during adulthood. I applaud the authors for recognizing this problem and the need for further study in Israel.

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