Heart defects, real but treatable - TRIBUNE

• Written by  Sade Oguntola
• Thursday, 17 October 2013 00:00

DO you have challenges with your heart?  Have you been told that your heart is defective and, as such, you need to have a heart surgery? Well, a diagnosis of heart defect or problem should not dim your hope for a brighter future, as evidenced by three young persons with heart problems that had open heart surgeries done on them at the University College Hospital, UCH, Ibadan.
It is devastating indeed for parents to discover that their child is born with a heart defect. But despite the grim implications of such a health condition, the progress in medical science has made it possible to treat this condition and enable the child to lead a normal life. This is evidenced by Kazeem John Ojo, a 19-year-old who, on the second day after he had an open heart surgery, asserted that he was stronger than he was for years.
Kareem’s heart problem started when he was 10 years old and in primary five.  His diagnosis of a malformed heart no doubt took his mother by surprise. “We were coming back from church when he complained of stomach ache,” stated his mother, Mrs Abigail Ojo, who weaves local aso oke in Egbeda, Lagos.
His referral to General Hospital, Ikeja, to see a heart specialist who asked that several tests be done gave the clue to what was the reason for the supposed stomach pain.
“The doctor, after the tests, said he had a heart problem and that the valve in the left part of his heart was damaged. He, however, did not explain what caused the damage. So, since then, he has been on treatment and he goes every other month for check up,” explained Mrs Ojo.
But Kazeem’s passion for football was been threatened by his easy tiredness and sometimes severe headache that left him unable to do anything. Although he knew he needed a heart surgery, the fact that the surgery would require over N3 million sometimes dampened his zeal.
Lucky came his way, however, when his doctors at the General Hospital, Ikeja, linked up with Dr Salami at the UCH, saying another heart surgery was to be done by some visiting heart experts.
“With merely N1, 250 in my bank account, I came with him to Ibadan since 9th of October, believing God for help,” said Mrs Ojo. Of course, many people had donated to Kazeem’s cause and to support his cardiopulmonary bypass surgery carried out by the trio of Dr Paul Davis, Dr Mudasiru Salami and Professor Victor Adegboye. But the joy of it all is that Kareem, who finished secondary school two years ago, had started to take fluids and already sitting up in bed even a day after the surgery.
Heart problems are real but progress in medicine is also giving people a new lease of life, Professor Samuel Omohkodion, the cardiac team leader at UCH, Ibadan where open heart surgery was carried out, explained.
“Heart problem occur in children and there are lots of children who are born with this sort of problem. There are two types of heart problems you find in children.
Some children are born with malformed hearts. The second type occurs in children because of various things in the environment such as infections that cause damages in the structures within the heart. Either way, such structural abnormality of the heart brings about a malfunctioning of their heart,” stated Professor Omohkodion, a paediatric cardiologist.
The heart is designed as a pump and there are two components of this pump, the systemic and coronary parts, which are coupled. The systemic part pumps blood round the body and the coronary part pumps blood through the lungs.  But when there is a structural anomaly, there may be a disruption of either component of these pumps.
For example, where there is a disruption of the systemic part of the pump, blood supply to the body would be inadequate, and, as such, the person may have a stunted growth. But when the pump to the lungs does not allow oxygenation of the blood to take place properly, such children are breathless. They are blue, coughing, and so on.
Unfortunately, Nigeria has its portion of children with heart defects such as hole in the heart too. According to Professor Omohkodion,  “On the average, we find between 9 to 12 cases per every 1000 live-births and that amounts to between 54,000 to 64,000 children born every year in Nigeria who have a structural anomaly of the heart.
“Cases of acquired heart problems are fewer. They form between 2 to 4 per 1000 children and that translates to about 20,000 new cases every year when we interpose that with our population of 160 million.”
Some of these heart defects will be of a mild nature and will not require treatment, while some will be severe and would require immediate treatment. But medical science has ability to treat such heart defects in children with or without surgery such as open heart surgery.
What is open heart surgery all about?  This requires a heart and lung machine to take over the roles of these organs while surgeons work on the heart to correct whatever is defective in it. Of course before the heart is worked on, fluids rich in calcium is passed into it to arrest it, thus ensuring that the heart no more beating.
But the patient is kept alive by the heart and lung machine.
After the necessary repairs have been done in the heart, it is closed back and the reconnected with the blood vessels and then restarted by passing a potassium rich fluid. But the tubes are not removed at once, until the heart starts to beat effectively and that usually takes about 24 hours.
No doubt, the UCH, Ibadan, is proud to lead in providing succour to people with heart defects and other heart problems. Professor Temitope Alonge, Chief Medical Director, UCH, Ibadan said: “It is an expensive venture. But quite honestly, it is not the equipment that actually makes the procedure (heart surgery). If you have all the money in the world and you don’t have the manpower, it is going to be  a waste. UCH, Ibadan, has both the manpower and equipment to do the job.”
Open heart surgery is however by no means cheap. “In Ghana, it costs between 2.2 to 2.3 million to have a heart surgery done and in India, it could range between 5,000 to 15,000 dollars depending on the hospital. So, in Nigeria, its cost cannot be anything less when compared to what obtains in other countries,” said Professor Alonge.
Of course, this was not the hospital’s first attempt at correcting defective hearts or surgically treating heart problems. He said: “In July, we did in heart surgery on eight patients, although they had medications to not to feel pain, they were not asleep.  These were done without anaesthesia as it were. But the open heart surgery is a lot more complex.”
Professor Alonge, who noted that medical students, doctors and everybody can watch as the surgery is done on a screen, thus affording them the opportunity to learn, said the hospital’s heart surgery was a sustainable one, being a Public Private Partnership intervention involving the Tristate Cardiovascular Institute, Delaware, United States and JNC International, a Turnkey Medical Equipment Solutions company.
“At a retreat with the Minister of health, Professor Onchebuchi Chukwu, it was agreed unanimously that expensive programmes like this must be run as a PPP initiative, otherwise, it is going to die. I do not intend for this to die and so it will run on PPP basis,” he said.
At the moment, the hospital intended to have about 60 open heart surgeries done within the next six months in its state of the art cardiac CATLAB facility. With the commencement of heart operations at the hospital, he stated, people need not travel abroad for heart surgeries again. “It will be more convenient to get treatment in UCH rather than to travel to abroad. If anybody is ready for treatment, we are ready to care for such,’’ he said.
Dr Kamar Adeleke, team leader, Tristate Cardiovascular Institutes, saying that open heart surgery was not a common practice in Nigeria, and as such patients who require it are referred abroad, described open surgery as a comprehensive approach to taking care of any kind of heart problem.
Although there are non-invasive methods of correcting problems in the heart which do not involve cutting open the chest, he stated, open heart surgery still comes in useful in some instances such as hole in heart cases and heart valve problems.
Dr Adeleke added: “in the case of the 19-year-old boy with a bad heart valve, if this valve is not replaced with a new one, in about six to 12 months, his situation would have worsened seriously. So, he is really lucky. Also, the other 9-year -old and 15-year-old children that had big holes in their heart are all cases that before now would have been referred for treatment abroad.”