‘One out of 100 children is born with heart disease’

A cardiologist specializes in diseases affecting the heart and the blood vessels. He studies the heart and the blood vessels. There are different 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 problems 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 help the heart function. They are the conventional cardiologists. We have cardiologists who deal with imaging so they do take pictures of the heart from different angles. They can use echo machine, MRI machines, CT scanners and nuclear radiation machines to look at the different ways the heart works and the way the heart functions and how it can be affected.

There are cardiologists who specialize in what can support the heart. They look at hearts that are weak and hearts that are failing. They specialize in ways 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 are born with a heart condition in childhood, who usually have to have series of operation in childhood to deal with their heart condition and when they hit 18 and become adults, 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 began to operate on these children to keep them alive. So 30 years ago, there were no adults who survived childhood to become adults with diseases they were born with unless they were very lucky and the diseases they had were very mild.

But now, no matter how complex these children’s situation was at childhood, they are now being operated and can grow into adulthood. Not only do they have the same problems they had as a child, but they experience similar problems as a normal adult. So a new breed of cardiologist is now coming forward to look after these patients.

There are a number of conditions that can predispose a woman to give birth to a child with a 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 old 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 prepare. When the child is born, you start 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. Whatever 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.

Among the populace, children with congenital heart defects are about 1 per cent of live birth. So, one in every 100 pregnant women who delivers 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 which would require an operation when they are young to correct before the child grows up.

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 and life expectancy. For more complex defects, the child doesn’t have just one operation, he needs to have two, three, four or 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.

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 can be done in the cat lab. For the more complex defect, the chances of survival are still very good 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 technology that exists, these children don’t always have to have surgeries anymore; only 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 called a catheter-based procedure.  

You can go through the groin 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, if you have an operation in the hospital you are admitted for a week before you can go home. I advise people in Nigeria to seek second opinion when they are told that their child has heart defect. They shouldn’t just accept that. There is more that can be done as there’s more knowledge available.

Any person having problem with four main things;  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 you got 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 been fully diagnosed or treated. The pregnancy will put you or the baby at risk.

It’s very different. Abroad, you have a lot more resources and a lot more tools 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.