Safer way to treat congenital cardiac defects

Maria Endah Hulupi, The Jakarta Post, Jakarta

Parents may feel that their whole world has turned upside-down when they find out that their children have been diagnosed as having congenital cardiac defects.

Although such defects of the heart can be treated by surgery, most parents have a hard time deciding whether to let their children undergo such an invasive procedure. Even worse, parents who decide upon a non-surgical alternative have had to reach deeper into their pockets, as children must be sent abroad in order to receive such treatment.

There is new hope now, as an alternative, non-surgical treatment for congenital cardiac defects has been made available here, particularly for the treatment of patent ductus arteriosus (PDA) and atrial septal defects (ASD).

PDA is an abnormal condition in which the arteriole fails to close after birth, while an ASD is a leak in the atrium of the heart.

As a matter of fact, the treatment has been available in the region for five years, but Indonesia, unlike neighboring countries Singapore and Malaysia, was unable to adopt the treatment due to the economic crisis.

A pediatric cardiologist from the University of Indonesia, Dr. Sukman Tulus Putra, said there is no data about the prevalence of congenital cardiac defects in Indonesia. However, the average international figure is about eight to 10 babies in every 1,000 births are born with such defects, or about 40,000 babies annually.

"Apart from the expensive surgical cost, most parents are worried about letting their babies undergo surgery, so they send their children abroad to receive this less invasive alternative to the traditional surgical methods," Sukman told the press at Siloam Gleneagles Hospital in Lippo Karawaci, Tangerang.

He added that this was also the reason why only 10 percent of babies with cardiac defect received treatment.

The alternative treatment is available at Cipto Mangunkusumo General Hospital (RSCM), Siloam Gleneagles Hospital, and Harapan Kita Hospital, as well as a few others.

The catheterization procedure, Sukman explained, is very effective for certain types of congenital cardiac defects, such as PDA and ASD.

Another expert, pediatric cardiologist Dr. Hasri Samion at Malaysia's National Heart Institute (IJN), said that in his country, the treatment has been performed with about 2,000 successful cases in the past five years.

IJN, in cooperation with RSCM, is providing training and supervision on the non-surgical treatment for pediatric cardiologists in Indonesia. Samion was recently in Jakarta to supervise the treatment, which was performed on 15 children with congenital defects at Siloam Gleneagles Hospital through a partnership program.

The procedure, Samion explained, is performed by inserting a catheter into the femoral artery and guidiing it to the area of the heart to be treated. The operator then releases a device, called an amplatzer occluder and made of polyester and nitinol, at the location and the device will expand to an umbrella-like shape that will block the leak, enabling normal blood circulation. Finally, the operator removes the catheter.

The 45-minute procedure, Sukman said, is very safe. It is relatively cheaper compared to surgical procedures, and the treatment lasts a lifetime.

"Unlike surgery, which usually takes about two hours followed by several days at the hospital, this treatment requires only one day's hospitalization," he said.

Additionally, unlike surgery that can leave a scar on the patients' chest, this non-surgical method would only leave a tiny mark on the leg.

The treatment, however, cannot be performed on patients with several leakages or those with too big an opening, which can only be treated by surgery. "In some cases, small defects can close naturally as the child grows, but in other cases, there needs to be immediate intervention to save the patients' lives," he explained.

Sukman said the symptoms that commonly accompanied the problem include shortness of breath, fatigue, especially when drinking or breastfeeding, and a stagnant body weight. Mothers who notice such conditions, he added, are advised to consult to their pediatrician immediately.

As for the cause of such cardiac defects, it remains unclear but may be triggered by several factors that occur during the first trimester of pregnancy. These factors include TORCH infections (toxoplasmosis, rubella, cytomegalovirus, and herpes), taking certain drugs or jamu (traditional herbal medicine), and exposure to radiation.

"The first trimester of pregnancy is a crucial period for the development of vital organs like the heart, so the pregnant woman must be extra careful," he warned.