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In the late 1990s, the field of cardiac catheterization for congenital heart disease is nearing the end of a period of rapid expansion, change, and diversification. Now is a good time to identify and assess many of these changes. This retrospective view serves more purposes than self-congratulation: it allows a clearer prediction of where the field is likely to go, and how it gets there. The first and most obvious change is the continued rapid growth of catheter-directed interventional procedures. A less dramatic but equally pervasive change has been the improvement in non-invasive diagnosis, primarily by ultrasound but increasingly via magnetic resonance imaging. A highly revolutionary change has been the consolidation and shrinkage of cardiologists who perform interventional procedures. Where will the next decade take the catheterizer and his or her colleagues? Perhaps into catheter delivery of gene therapy to treat inherited myopathies or vasculopathies. Even likelier is the use of catheters to implant pulmonary valves made from a patient’s own tissue. Likelier still will be the demise of film and the continued emergence of the multimedia laboratory. Underlying the success of any and all of these changes will be a commitment to rigorous self-criticism and self-analysis. A renewed commitment to these values is especially important at this time for the field of diagnostic and interventional catheterization in congenital heart disease.
