‘One Out Of 100 Children’ll Develop Heart Disease’

A Canada-based Nigerian adult congenital heart disease expert, Dr Enitan Majekodunmi, talks to WINIFRED OGBEBO on the practice of cardiology and the range of treatment available for children born with heart defects.

What are the different specialties of cardiology?

A cardiologist specializes in diseases affecting the heart and the blood vessels. So it’s not just the heart but also the blood vessels as well. There are lots of parts of cardiology that you can specialize in. So, even if you are a general cardiologist, you can pick a part of cardiology to specialize in. The heart works with electricity so the heart in its own way, has its own generator which generates electricity.  Some people can have problem, with electricity in their hearts and those specialists who deal with that are called electro physiologists. We have people who deal   with the arteries around the heart; the arteries that supply the heart itself. They are the conventional cardiologists. We have cardiologists who deal with imaging so they do take pictures of the heart with many different things. They can use echo machine, MRI machines,  CT scanners and nuclear radiation machines to look at the lots of different  ways that the heart works and the way the heart functions and its affected. There are cardiologists who specialize in  able to support the heart. They look at hearts that are weak and hearts that are failing. They specialize in ways to try to keep the heart working. So we call them heart- failing specialists.

My particular specialty is called adult congenital heart disease. I deal with patients who have generally been born with a heart condition in childhood, who have usually had to have series of operations in childhood to deal with their heart condition and when they hit 18 and they become adults, then we take over their care and we look after them. It’s actually a very new specialty in cardiology because 30 years ago, patients who were born with heart disease didn’t survive. It’s only about 30 years ago that they started being able to operate on these children and were beginning to keep them alive. So 30 years ago, there were no adults really who  survived childhood to become adults with diseases that they were born with unless they were very lucky and the diseases they had were very mild to begin with. But now, no matter how complex these   children are in childhood, they are getting operation and they are all now growing up and becoming adults. Not only do they have the problems they had as a child, but they are getting the same problems as a normal adult get. So a new breed of cardiologist is now coming forward to look after these patients.

 

What predisposes a woman to give birth to a child with heart diseases?

There are a number of conditions that can predispose a woman to giving birth to a child with heart condition. One of them is rubella. It’s very important for women when they are pregnant to go for ante natal care and they should be checked for a lot of diseases that can be prevented; one of them being rubella.

Things like diabetics also predispose a woman to having a child with heart defect.  A woman who has infection is also predisposed.  To be honest, if a woman herself has congenital defect as well which she may or she may not know about, predisposes her to having a child with a heart defect as well.

 In some developed countries like the UK and US, all pregnant women will get a scan when they are 20 weeks to look at the heart of the foetus; to see if its normal or abnormal. So in more than 90 per cent of cases, when a child has a congenital heart disease, they already know about it before the child is born. What that allows you to do is that it allows you to prepare. If you know that, when the child is born, you need to start on some certain medication so that the child can be well until he needs to have an operation.

When a woman is 38 weeks pregnant, there’s a plan in place until she delivers. Wherever hospital she goes, she’s placed on medication immediately the child is delivered and they can transfer the child to the cardiac centre where the operation will be done at a later stage. It could be two or three days later but at least, you know that the child is going to be well and stable until he comes to the cardiac centre.

 In the general population alone, children with congenital heart defects are about one per cent of live births. So, one in every 100 women who deliver a child will give birth to a child with a heart condition. Luckily, most of those heart conditions are simple and do not usually cause the child a problem. There are a few that are quite complex that again these children would require an operation when they are young to correct and deal with before the child can grow up.

 

Is the operation and treatment for a child with a heart defect permanent?

 Most of them can be treated permanently when a child is born; those with simpler defects. Once they are treated they usually don’t require another operation. You’ll expect that that child will have a normal existence, normal life expectancy. For more complex defects, and the child doesn’t have just one operation, he needs to have two, three, four and five operations in childhood, and even so, for the most complex patients, they don’t always have a normal life expectancy.  We know that when they get to, maybe 30 years of age, they run into very serious problems that can’t be fixed by operations anymore and then the only thing that can be done is a heart transplant.

 

How is a heart transplant done?

Usually, it can be done in children and also in adults too. You just need a new heart. What happens is that in countries that run a transplant programme, people can elect to carry donor card so that if they are involved in a car accident or when they die, they agree to have their organs donated to somebody who needs it. The chances are not high because not a lot of people donate or agree to be donors. So there’s lot more people waiting for heart transplant than there are available donors to treat them.

 

What are the chances of survival for a child with heart defect?

It depends on the defect. For the simpler defect, the chances of survival are excellent if you have access to the right expertise; surgical and interventional techniques that we can do in the lab. For the more complex defect,  the chances of survival are still very good at survival but obviously, that is a child in the UK, US or Canada. In Nigeria, those facilities don’t just exist. So, for those children unless they are very lucky to be in a place where the right person can make the right diagnosis, and they are referred to India, they don’t register much of a chance.

 These days, with the lot of simpler defects that exist, the good news is that, with the lot of technology that exists, these children don’t always have to have surgeries anymore; where they have to have their chests and their hearts opened and their defects repaired. A lot of things these days we can now do through what we call a catheter-based procedure.  You can go through the groin , go to the heart.  You can close holes that way, if there are holes in the heart. You can change valves that way; there are lots of things that are narrow that you can make open. There are a lot that can be done these days that you don’t need a big operation for. You can come in one day, have it done that day and go home the next day. In the old days, you have an operation in the hospital for about a week before you can go home. I advise people in Nigeria to seek second opinion when they are told that their child has a heart defect. They shouldn’t just accept that. There is more that can be done as there’s more knowledge available.

 

What are the symptoms of a heart defect?

Any person having problem with four main things; you have chest pain especially when you are doing something, if you are short of breath when you are doing very little, if you get a lot of pounding in your chest that you think it’s coming from your heart, if you faint suddenly without warning and you don’t know why, try and go and see a cardiologist. It can be a life-saving thing sometimes. Some of these things can be warnings before something life-threatening happens.

Also, if you are a woman looking to get pregnant, and you know that there’s something wrong with your heart, you had a problem with your heart before, before you get pregnant, it’s also good to see a cardiologist. Sometimes, it can impact on the safety of the pregnancy if you have a heart condition that has not been dealt with, not being fully diagnosed or treated. The pregnancy will put you or the baby at risk.

 

How would you rate the practice of cardiology in developed countries like Nigeria?

It’s very different. Abroad, you have a lot more resources and a lot more tools to be able to treat them. Like I said, every woman will get abdominal scan at 20 weeks of pregnancy to make sure that her heart is normal or abnormal. That is one thing that is not readily available in Nigeria. So most women will find out whether their child has heart defect or not after delivery. Even after delivery, the kind of operation for the most complex defect, done so easily with minimal or low risk, is readily available in the western world. In Nigeria, it is not available. From my interactions with people here, most of the operations that need to be done for those who need it, are arranged by the people themselves who go to India for such.



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