Mannheimer Lecture 2026: paediatric cardiology across the lifespan: building the future of congenital heart care

BACKGROUND: Traditionally, pediatric cardiology has been fundamentally reactive: structural abnormalities were diagnosed, symptoms developed, complications occurred, and clinicians responded. Increasingly, however, the field is shifting upstream from reaction to anticipation. OBJECTIVES: To highlight the transition from reactive to predictive pediatric cardiology and discuss the implications of integrating molecular and computational approaches into the management of congenital heart disease (CHD). METHODS: Narrative review of emerging concepts in precision medicine, focusing on the integration of genomics, transcriptomics, proteomics, other multi-omics technologies, advanced cardiac imaging, and computational analysis. RESULTS: Multi-omics approaches demonstrate that CHD is not solely an anatomical disorder but also a biological disease. Distinct molecular pathways may explain why patients with apparently identical cardiac anatomy experience markedly different clinical trajectories. The combination of molecular profiling, advanced imaging, and computational analysis enables more accurate risk stratification and earlier prediction of disease progression, paving the way for personalized management strategies. CONCLUSION: The transition from reactive to predictive medicine represents more than a technological advance; it fundamentally redefines the role and responsibilities of pediatric cardiologists. As the ability to anticipate disease progression improves, clinical decisions must increasingly be made before overt manifestations appear, raising new opportunities and responsibilities regarding the timing and appropriateness of intervention.