use or operation of any methods, products, instructions, or ideas contained in the material herein Previous editions copyrighted 2010, 2002, 1987 by Churchill Livingstone, an affiliate of Elsevier, Inc Diane E Spicer retains copyright of her images Library of Congress Control Number: 2018944861 Content Strategist: Robin Carter Content Development Specialist: Lisa Barnes Publishing Services Manager: Catherine Jackson Senior Project Manager/Specialist: Carrie Stetz Design Direction: Ryan Cook Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 Dedication To Alison, Sarah, Dan, Caroline, and Susie for all the joy you bring to my life J.S.T To my parents, Sasikala Raman and AK Raman K.K To my wife Katie for her support, and my children Adelyn, Jonas, and Rylan for their inspiration J.T.T Foreword I little thought, when writing along with my colleagues the preface to the first edition of this textbook, that 33 years later I would be invited to provide the foreword to the fourth edition Much has changed over that period, not least the tragically early loss of Fergus Macartney, one of the original editors I am pleased to report that Elliot Shinebourne and Mike Tynan, our other original conspirators, continue to enjoy their retirement For myself, it has been a pleasure to update the anatomical content of this latest version of the book This would not have been possible without the efforts of Diane Spicer Her photographs of the congenitally malformed heart that grace this fourth edition show the anatomic features with ever increasing accuracy and beauty The major change in this fourth edition has been the remarkable shift in the geographical representation of the editorial team Our first edition was an intentionally anglocentric affair It is of minor historical interest that, when discussing the potential publication of the textbook with Andrew Stephenson, the publishing director of Churchill Livingstone at the time, we dined at their London offices The upstairs storey of their premises, in Bentinck Street, had been the apartment, during the Second World War, of Guy Burgess, one of the notorious members of the ring of “spies” that chose to share our national secrets with the old Soviet Union When preparing the content of our first edition, we took care to include European and transatlantic contributions This proved possible through our collaborations with close friends and colleagues, particularly those working in Amsterdam and Pittsburgh In our second edition, we were joined by two of our own fellows, Ted Baker and Mike Rigby, who had risen to their own prominence The editorial team, nonetheless, remained firmly embedded in London This then changed with the third edition By this time, Elliot and Mike had chosen to hand on their editorial batons to Dan Penny and Andrew Redington Trained by Elliot and Mike at the Brompton Hospital, they had, by then, achieved their own international recognition, being appointed to major positions in Melbourne and Toronto This diaspora in itself was sufficient to