Safer way to treat congenital cardiac defects

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.