Tygerberg Hospital commemorates Congenital Heart Defects awareness week
Annually, international congenital heart defects (CHD) awareness week is celebrated from 7 to 14 February. The Division of Cardiology at Tygerberg Hospital has a well-established reputation in the management of CHD as well as the imaging techniques required to diagnose rheumatic heart disease (RHD).
CHD is when a baby is born with a defect of the structure of the heart. According to the Centres for Disease Control (CDC), congenital heart defects affect almost 1% of births in the United States every year. This obviously includes a wide spectrum of disease, ranging from severe defects not compatible with life to much milder forms. For this reason, only about 25% require early surgery during the first year of life and the rest are treated at a later stage or remain without symptoms for decades. It is therefore very possible to have a CHD without knowing it. However, in some cases, this may put strain on the heart over years and when it is finally diagnosed, may already have caused significant damage to the heart. Accurate data on the prevalence of CHD for South Africa is lacking.
Another major heart condition affecting an estimated to 3 million people worldwide is RHD. This is caused by a bacterial throat infection that cross reacts with the tissue of heart valves and leads to damage of the valves. It affects mostly younger people but because it is focussed on lower income countries, there is less funding for high quality research into the prevalence. This is a major stumbling block in the management of RHD.
A recent large-scale research project undertaken by the hospital’s division of cardiology brought these two conditions together and resulted in some unexpected positive outcomes for a few young people. The Echo in Africa project was spearheaded by Dr Philip Herbst of the Division of Cardiology and in collaboration with the British Society of Echocardiography, a system was developed to screen healthy school children for RHD. High quality echo (ultrasound) scans were performed both at Tygerberg Hospital and at the schools, and 7 100 children were screened. A total of 180 cases of RHD could be diagnosed and these children can receive treatment, but a further 60 cases of undiagnosed congenital heart defects were diagnosed. These children were then referred as appropriately: some will just be monitored, some required open heart surgery, and some could be treated with keyhole procedures.
Dr Hellmuth Weich, acting head of the Division of Cardiology, said: ‘One such patient was diagnosed with a hole in the heart between the left and right atria. This leads to blood from the left shunting across to the right side of the heart, leading to an increased volume of blood going through the heart and may be fatal if left untreated. After the diagnosis was made, she was admitted for transcatheter (via a thin tube placed in a vein or artery) closure of the defect by the team at Tygerberg. A tube was inserted into her leg vein and advanced up to the right heart where the hole was identified with an ultrasound probe placed in her gullet (see attached images). The tube was passed through the hole into the left atrium and a metal “double umbrella” device was deployed to close the hole. The first “umbrella” disc was opened in the left atrium and the device was then pulled back to straddle the defect, and the second disc was deployed in the right atrium. The device is then detached from its delivery cable and the tube removed. The patient can go home the same day and usually does not suffer discomfort from the procedure. This is a single success story and only a small part of the ongoing services provided by the team at Tygerberg Hospital’s Division of Cardiology.