Monday 18th February, 2008

 

Congenital heart disease

 
 
 
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Dr Kamal Rampersad, managing director of Caribbean Heart Care Medcorp, Cardiac Surgery Department, Adult and Paediatric at Eric Williams Medical
Sciences Complex, Mt Hope.

BY MARSHA MOKOOL

Congenital heart disease is responsible for more deaths in the first year of life than any other birth defect in this country.

This was confirmed in an interview last week with Dr Kamal Rampersad, an anaesthetist and head of the Caribbean Heart Care Medcorp, Cardiac Surgery Department, Adult and Paediatric at Eric Williams Medical Sciences Complex, Mt Hope.

Congenital heart disease (CHD) is a type of heart disease in newborns. The defect may be so slight that the baby appears healthy for many years after birth, or so severe that its life is in immediate danger.

Stages of the disease

Symptoms of congenital heart disease can range from simple to complex heart disease with the least complex presenting itself in adulthood, such as in the case of Guardian journalist Zen Dionne Jarrette, who passed away on January 11.

The middle to complex stages of the disease affects 80 per cent of children born with this condition and the majority of them require surgery in childhood.

The complex stage of this disease is present from six months to one year and the middle stage presents itself from three to six years of age.

What is congenital

heart disease?

Congenital heart disease exists primarily at birth and can describe a wide variety of congenital heart defects. It occurs when the heart or blood vessels next to the heart are not generated properly before birth. Therefore, the heart does not function properly because it is not completely developed.

Heart defects originate in the early part of pregnancy when the heart is forming, usually in the first eight to nine weeks during pregnancy.

Genetic and

environmental factors

Multiple genetic and environmental factors interact to alter the development of the heart during the early stages of a foetus’ development. Certain environmental exposures during the first trimester of pregnancy may cause structural abnormalities. However, they can also be a part of various genetic and chromosomal syndromes such as Down syndrome.

Environmental factors include exposure to anticonvulsant medications, lithium, dermatologic medications, alcohol and drugs during pregnancy. Exposure to industrial chemicals during pregnancy can also increase the risk of congenital heart malformations.

Women who contract rubella (German measles) during the first three months of pregnancy also have a high risk of having a baby with a heart defect.

But most of the time, the specific cause of congenital heart disease is not known.

“About half the cases in this country are related to Down Syndrome,” said Rampersad.

Teratogenic drugs, which are agents that can disturb the development of the embryo or foetus, may be responsible for most of the non-genetic cases, he said.

Congenital heart

disease in adults

Although the majority of congenital heart disease diagnoses are made in childhood, there are significant congenital heart defects which may go undetected until adulthood.

Some congenital heart diseases can be treated with medication alone, while others require one or more surgeries.

“If you have a congenital heart defect, it will present itself sometime in your life,” said Rampersad.

Defects include certain kinds of valve problems, transposition disorders, holes in the heart, and abnormalities of the heart’s major veins and arteries. The most common congenital heart disorder diagnosed in T&T is holes in the heart, which may or may not require surgery, according to Rampersad.

“Many children born with complex heart defects grow to adulthood and lead productive lives. Very rarely in about two to three per cent of cases this condition can heal with time.

“But those that don’t heal with time will become symptomatic in adult years. It usually does not affect life span but patients are required to make changes in their lifestyle,” he said.

Congenital heart defects are most commonly diagnosed through an echocardiogram—an ultrasound of the heart which shows the heart’s structure.

“An echocardiogram will determine if surgery is required,” he said.

Statistics of cases

Statistics compiled by Caribbean Heart Care Medcorp in 2001 showed that 61 children in T&T had open heart surgery that year. Further data showed that 36 of them had holes in their heart or congenital heart disease.

“This means 60 per cent of children who had open heart surgery in 2001 had holes in their hearts. Our statistics also show that two per cent of adults who had open heart surgery in 2001 had holes in the heart. That two per cent represented three cases of adults with congenital heart disease,” said Rampersad.

He also stressed that T&T has one of the best success rates for heart surgery in the world with a fatality rate of just 1.5 per cent in adults.

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