Improved methods of detection, and the survival of patients who formerly died during infancy or before reaching reproductive age, may well reveal a much larger incidence of congenital heart disease.1 However, the number of patients who require cardiac catheterization for definitive diagnosis will not increase. The very fact that 12 years' experience with the technique has increased the accuracy of clinical diagnosis accounts for the lessened frequency with which cardiac catheterizations are now done.2 It is apparent that precise diagnosis in a majority of patients with congenital heart disease as well as patients with acquired heart disease may be achieved by purely clinical techniques.3
The detailed history, physical examination, x-ray studies, and electrocardiographic data are often sufficiently distinctive for definitive diagnosis. This is most vividly demonstrated by recent practice at the Mayo Clinic, where about 90% of pediatric patients with tetralogy of Fallot are referred
Weil MH. CARDIAC CATHETERIZATION FOR DIAGNOSIS: DECREASED NEED, INCREASED COMPLEXITY, AND GREATER EXPENSE. JAMA. 1959;171(12):1647–1648. doi:10.1001/jama.1959.03010300021004
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