Congenital Heart Disease

History

First trained pediatric interventional cardiologist Dr Nurun Nahar Fatema started her works in combined military hospital Dhaka in Sept 1998. Initial interventions were Balloon atrial septostomy, Pulmonary valvoplasty, Aortic valvoplasty, Coarctation balloon angioplasty, PDA coil occlusion etc. ASD device closure was started in 2000 followed by VSD device closure in 2004. Than coronary fistula closure, stenting of vessels started gradually. Lastly, pulmonary valve replacement was started in the same center as first ever center of South Asia in Dec 2012.
Medical management of various diseases and neonatal medical and interventional management by life-saving interventions also started in 1998. Manipulation of PDA with Indomethacin and prostaglandin was first started in CMH Dhaka in 1999. Treatment of persistent Fetal circulation and Persistent pulmonary hypertension of newborn was also started with the special self-designed protocol from the year 2000. Hundreds of newborns life was saved by above-mentioned treatment.
Other hospitals like NICVD, National heart foundation, Ibrahim cardiac hospital, Shishu hospital are giving coverage to the mass population. Pediatric cardiac surgery is doing a wonderful job in national heart foundation, NICVD and recently in Ibrahim Cardiac Hospital. NICVD is trying to bring the technology of intervention from charity program since 2011. The lab aid cardiac hospital is giving coverage of large no of OPD and Echo cases of children. The central hospital is a general hospital but its NICU is giving coverage to large no of a newborn with CHD especially medical management of neonatal emergencies.
Other private hospitals also have some form of the pediatric cardiac program through a number of pt is not so significant. At present, about 30 specialists are working in the field of pediatric heart care in Bangladesh. Some are taking training from abroad and will join soon to existing manpower.
In this background, we are forming an interactive working group on Structural and Congenital heart disease in Bangladesh to address the problem. We have an aim to exchange our knowledge and experience on this subject and to pursue continuous medical education regularly in this quickly expanding and challenging subject. At the end, we all together will work hard to ensure a better future for children with congenital heart disease.

Background

Bangladesh is one of the largest deltas in the world with a population of 163,654,860 (July 2013). The Birth rate of the country is 22.07 births/1,000 populations. A growth rate of population is 1.59% and 31.55% of population lives below poverty line..To meet the challenge for health of the nation we have very small no of physicians. The physician density of the country is 0.356 physicians/1,000 population (2011). Among these physicians, we have a very few pediatric cardiologists (about 20 in number), pediatric cardiac surgeon and pediatric cardiac anesthesiologist.
Congenital heart disease refers to structural or functional heart disease present at birth, even if first discovered later.
The incidence of congenital heart disease is the rate that refers to the number of children born with congenital heart disease related to the total number of births over a period of one year. Incidence varies from 6—10 / 1000 live births in various studies conducted in many centers. In Bangladesh incidence was found up to 25/ 1000 live birth in one center (CMH Dhaka). Infant mortality rate of 47.3/ 1000 live birth is also contributed a lot by the death of infants from congenital heart disease.
The resources are limited in our country and also improperly utilized. There is no national policy yet for pediatric heart care. There is no national database on incidence or prevalence of this disease.
No pediatric cardiologists are available in any of the peripheral medical colleges outside Dhaka city. As 60% of populations are very poor, most of the patient do not visit any physician and die at home. Few can visit up to District level hospital but cannot manage money to travel to Dhaka city to reach a pediatric cardiologist. Few are lucky to complete first work up from capital city but cannot manage money to complete treatment by trans catheter or open heart technique. A very small fraction can complete all treatment from home or abroad.
There is lack of awareness also among general populations about symptoms of congenital heart disease, Even physicians also have a false belief. Some doctor believes that CHD has no treatment, some doctor believes that treatment should be done at 10 years of age or when a child will reach 10 kg etc. Some doctor believes that trans catheter technique of closure of holes are dangerous because the device will dislodge after some time.