The Heart manuscript by Cuypers et al1 describes the late outcomes of patients who have undergone surgery for pulmonary valve stenosis, an operation that has now become obsolete. Since the beginning of the eighties, congenital pulmonary valve stenosis has been treated so efficiently by balloon dilatation that, from 1 day to the next, surgery for this lesion had all but disappeared. Balloon dilatation stretches the annulus with valve remnants being pushed away, while surgery consists almost invariably in the complete resection of the dysplastic pulmonary valve. The mechanisms of relief of the stenosis by the two techniques are therefore so different that it is likely that the description of the late outcomes obtained by surgery will not be informative on the late outcomes of balloon dilatation. The current study, nonetheless, gives us precious information.

There are now more adults with congenital heart disease than patients in the paediatric age.2 In an era when the development of complications in the first two decades after surgery has been better circumscribed, the unsolved question we are still facing is whether or not patients who have been previously affected by congenital heart surgery will have any survival or functional disadvantage as they grow into an old age. The number of studies reporting outcomes up to four decades after surgery is less. In this …