Between June 1984 and October 1986, we evaluated 22 children for possible cardiac transplantation at Columbia-Presbyterian Medical Center. Four children died awaiting donor organs. Fifteen children received transplants; eight had cardiomyopathy, and seven had congenital heart disease. One child received a heterotopic transplant because of extremely high pulmonary vascular resistance. Immunosuppressive therapy consisted of 4 to 40 mg/kg/d cyclosporine and 0.2 to 0.5 mg/kg/d prednisone. Rejection was detected by the presence of myocyte necrosis in surveillance endomyocardial biopsy specimens. There were one intraoperative and three early deaths, two from infection and one rejection. The 11 survivors are observed from a few weeks to more than 2 years after transplantation, and all are in excellent clinical health and participate in age-appropriate activities. These data corroborate the experience of other institutions that cardiac transplantation is a valid treatment in children.