Congenital Heart Diseases

Congenital heart diseases (CHD) are defects of the heart that occur during the formation of the foetal heart and the major blood vessels. The word “congenital” means that it existed at birth. The terms “congenital heart defect” and “congenital heart disease” are often used to mean the same thing, but “defect” is more accurate.

The heart ailment is a defect or abnormality, not a disease. A defect results when the heart or blood vessels near the heart don’t develop normally before birth. A congenital heart defect is a condition where a child is born with a physically abnormal heart.

No definite cause has been identified but CHDcanbe categorised into two groups.The more complex Cyanotic (those who become blue due to the heart disease) defectsare combinations of holes and narrow valves or under-developed cardiac chambers. The less dangerous Acyanotic (those who remain pink even in the presence of a heart disease) defectsinclude a simple hole in the heart, narrowing of a heart valve or incompetence of a heart valve.

CHD is more common than acquired disorders, affecting an estimated 3000 new-borns every year in Sri Lanka. It is one of the most common birth defects in children, and a major contributor to morbidity and mortality in children under five years of age.

It is an established fact that CHD is a major killer ofchildren and a main contributing factor to the infant mortality rate (IMR). In a country where alarge number of children dieof easily treatable diarrhoeal diseases or respiratory infections, which can be controlled at a much lower cost, a government sponsored paediatric cardiac program will not be successful as the likelihood of the child dying of infectiousdiseases is high.

The best example of a government-sponsored paediatric cardiac program comes from Cuba. They observed that their IMR had dropped to below 20/1000 live births by 1980. As infant mortality declined, CHD became the primary cause of death in infants less than 1 year of age. Consequently, they strengthened their paediatric cardiology program in early the 1980s and as a result the IMR in Cuba has steadily declined to its current level of 5/1000 live births and has remained static over the past 4years.

Sri Lanka with its excellent public healthcare system and low mortality (8/1000 live births) is now ready to set up and maintain an internationally recognised tissue bank.

LRH has come a long way inregard to children’s heart surgeries but further advancement is essential with a dire need for their own Tissue Bank.Tissues from cadavers, which are needed for heart operations including valve repair, have to be stored and that’s why we need such a bank. Such tissues, as opposed to commercially available prosthetics, are the best when considering longevity.

We consider establishment of a human heart valve bank as one of our major priorities in the development of paediatric cardiac services in Sri Lanka.