The Paris group of Hôpital Necker-Enfants Malades have reviewed 89 patients who have grown up with a univentricular heart, and their findings are presented in this issue ofHeart.1 First we should congratulate Saliba and his colleagues for undertaking this study and providing the data. In an editorial in Heartin 1993 Fallowfield wrote “ . . .cardiologists have been slow to routinely employ appropriate measures to assess quality of life.”2 Since then there have been 145 papers in theBritish Heart Journal or inHeart with “quality of life” in the title or abstract. Cardiologists have risen to the challenge.

At the time of Saliba's survey the 89 patients ranged in age from 17–49 years with a median of 21 years, and we can deduce that the ages are bunched around the late teens and early 20s. Most have undergone palliative procedures including venous (cavopulmonary or right atriopulmonary shunts) or arterial (aortopulmonary shunt) diversion. Four have had a heart transplant and another four were on the waiting list. They were very unwell from any reasonable cardiological standpoint. We see that 10% had fixed pulmonary hypertension, 20% were in congestive heart failure, 40% had a cardiac rhythm disturbance, and 60% were cyanotic at rest.

It is then remarkable to read that “the [QoL] scores of adults with univentricular heart were similar to the normal population”. Again I believe congratulations are due to the group. Not withstanding their very heavy burden of …