Some achievements in the treatment of congenital heart defects are discussed. Special comments are made about the persistent ductus arteriosus, atrial septal defect, transposition of the great arteries and the Fontan operation. The differences and similarities between 'corrective' and 'palliative' operations are discussed. The history of the development of supraregional centres in England and Wales is described and the current situation outlined. The relationship between the number of operations performed and results is emphasised. Current and future training of paediatric cardiac surgeons is discussed and proposals made for the future organisation of care for children with congenital heart defects. The author speculates about how these problems will be solved in view of the decreasing number of children with congenital heart defects. Impact of treatment on the families of patients with congenital heart defects is also considered.