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In the 17 years since the first publication of Anesthesia for Congenital Heart Disease, each successive edition has seen a significant expansion in the material in the book due to the ongoing rapid advances in the field of congenital heart disease (CHD). The Fourth Edition marks the greatest number of changes since the conception of this book, and the new chapters and content, including thorough chapter updates and the addition of many more figures and tables that illustrate the myriad of changes in this field, are designed to further enhance the knowledge of the anesthesiologist and others caring for CHD patients. The continued participation of a number of international authors contributes to the many perspectives represented in congenital cardiac anesthesia care; it truly is a world- wide field. Chapter 4 is a new chapter entitled, “Multidisciplinary Collaboration, Team Functioning, and Communication in Congenital Cardiac Care.” This chapter emphasizes the unique nature of an often large, multidisciplinary team that must work together to make complex patient care decisions, and then perform the procedures and care that result in the best possible patient outcomes. It also focuses on the role of the Congenital Cardiac Anesthesiologist, not only to provide patient care but also to make substantive contributions to clinical decision- making and leadership in the Heart Center. Another new chapter is Chapter 5, “Informatics and Artificial Intelligence in Congenital Heart Disease,” which presents an overview of this crucially important field of medicine, which has a number of applications in Congenital Cardiac Anesthesia and Critical Care, and CHD in general. Chapter 8 is entirely devoted to Genetic Syndromes in CHD; an increasingly recognized and important aspect in the care of patients with CHD; it seeks to inform the anesthesiologist about the genetic underpinnings of many syndromes in CHD, their multisystem involvement, and the ethical principles of providing care for this complex population. Chapter 17 presents Point of Care Ultrasound in CHD, which has become an increasingly important skill for the Congenital Cardiac Anesthesiologist, not only to assist in vascular access procedures but also to assess the heart and lungs during procedures and emergencies to guide diagnostic and therapeutic choices. Finally, Chapter 25 is dedicated to Cardiac Arrest and Resuscitation in CHD, which has many unique features as a result of the anatomy and pathophysiology of these patients. The Key Points and Selected References are again included in all chapters, to enhance the reader’s learning and provide an opportunity for further knowledge. We are pleased to welcome as Editor Erin A. Gottlieb, M.D., M.H.C.M., our former Texas Children’s Hospital colleague who is now Chief of Pediatric Cardiac Anesthesia at Dell Children’s Medical Center, and the University of Texas Dell Medical School in Austin, Texas. Two editors from the Third Edition, Drs. Stephen Stayer and Wanda Miller- Hance, have retired from this role, and we wish to thank them for their many contributions to previous editions, and for their ongoing work as chapter authors for the Fourth Edition. We would like to dedicate this edition of the book to Dolly D. Hansen, M.D. who passed away in 2021. Dr. Hansen came to Boston Children’s Hospital (BCH) in 1971 for a Pediatric Cardiac Anesthesia Fellowship and spent the remainder of her career there until her retirement in 2001. Among the many firsts that Dr. Hansen was an integral part of was the establishment of the neonatal arterial switch operation as the preferred surgical strategy, the first Stage I Palliation for Hypoplastic Left Heart Syndrome, the first deep hypothermic circulatory arrest case at BCH, and landmark studies of high- dose opioid anesthesia and survival in neonatal cardiac surgery. Dr. Hansen was not only an outstanding clinician, but she also had a profound effect as a teacher of a very large group of anesthesia fellows at BCH. As one of the first female Pediatric Cardiac Anesthesiologists, Dr. Hansen paved the way for many to follow in her footsteps. Dr. Hansen was awarded the inaugural Congenital Cardiac Anesthesia Society Lifetime Achievement Award in 2021, a richly deserved honor for a singular career. She will be missed by all. The COVID- 19 pandemic has profoundly affected society and has caused more than 1 million deaths in the United States and over 6 million deaths worldwide as of the time of this writing. COVID- 19 has also affected care in CHD, and a new disease, Multisystem Inflammatory Syndrome in Children, often has cardiac involvement with some patients requiring inotropic and even mechanical support of the circulation. The high number of COVID- 19 positive pediatric patients in many parts of the world has led to widespread screening for infection with SARS- CoV2, and alteration of many aspects of anesthetic care, including personal protective equipment and airway protocols.