**2. Intentions of cardiac care development assistance**

The overarching goal of cardiac assistance should be the development of an independent program of cardiac care capable of sustainability. Depending on the local situation such an endeavor may take only 2–3 years for a pre-existing program to as many as 7–10 years if you are building a program *de novo* [3, 4]. The timelines are not firm, as the major determinants of the speed of development are local leadership, visiting team commitment, consistent funding, and a supportive government. The key component to all the above is trust.

Good intentions without trust by all sides will result in a failure of development. Building relationships is critical to the success of advancement and attainment of the primary goal. Therefor it is important from the outset to create an environment that results in the delivery of the promise and goals. You cannot develop relationships and trust if you do not provide the opportunity for the local team to participate and grow through a program of mentored graduated responsibility. Those teams that provide services only and allowing only limited participation by the local team are not upholding the promise and as such trust will not be developed and a rapid disconnect will occur, thus dooming program development. There are few times and places where the local team cannot be developed, and the visiting team simply provides all the care without education [5]. Beneficence cannot be directed at only the children receiving operation at the time of a visit, this is only a part of truly doing good work. One must consider the local team and the children that are still waiting for surgery and those not yet born. The idea of assistance is to build a program that benefits many children for years to come.
