hree days after he was born Nong Prin began to breathe more rapidly and his skin took on a bluish tint. It became difficult for his mother to feed him because he would have violent choking fits which would leave him exhausted. As a result of his condition, the infant was not gaining weight and developing as he should.
Chairat Sirikanon is 11 years old. He enjoys school but cannot take part in sports or physical education classes. any sort of exercise – even playing around with his friends – wears him out. He often gets frustrated with his inability to lead a normal, active life.
These two boys were subsequently diagnosed as having a congenital heart defect.
“Sometimes, my son’s heart makes a certain sound,” said Ratsarin Saithongthanaphun, Nong Prin’s mother.
“I got a terrible shock when I was told that my son had a problem with his heart. It was very depressing to learn that he needed an operation to fix the defect. He was only a year and a half old. It was a catastrophe!”
That “certain sound”, Ratsarin spoke of, is called a heart murmur – a swishing or whistling that is very noticeable if listened to through a stethoscope. It is caused by a defect that changes the way the blood flows through the heart.
“But not all murmurs are a sign of congenital heart defects,” said Dr Kraisorn Juthacharoenwong, a paediatric cardiologist at Samitivej Srinakarin Children’s Hospital.
Symptoms of congenital heart defects can be detected in newborns a few weeks after birth, he noted. In severe cases, infants’ hearts fail and they need urgent medical attention soon after birth. less severe defects may not be diagnosed until a child grows older.
Each year, between 7,000 and 8,000 children are born in Thailand with heart problems. Doctors don’t know what actually causes most of these defects, but think that heredity may play a role.
“In about 15% of cases we know the reason for the defect,” he said. “For the rest, the cause has never been ascertained.”
Children with genetic defects often have congenital heart defects, with Down’s syndrome kids being a classic example. “Half of babies with Down’s syndrome suffer from congenital heart defects.”
There is also a link between congenital heart defects and the consumption of large amounts of alcohol and certain drugs by expectant mothers. Poorly controlled sugar levels in pregnant women who have diabetes are also associated with a high rate of defects. Mothers-to-be who contract rubella during pregnancy also run a high risk of giving birth to infants with heart defects.
“Street drugs, like amphetamines, can, of course, have a negative effect on unborn children, too,” said Dr Kraisorn. “Pregnant women should receive good prenatal care. Screening and diagnostic tests are important. Women carrying babies suffering from serious heart defects may be advised to terminate the pregnancy.”
Defects can be structural – a hole in the wall of a heart chamber, for instance, or a malfunctioning valve – or may be related to the way blood flows through the arteries and veins that connect the heart to the rest of the body.
Heart disease can occur in children after birth as a consequence of rheumatic fever, rheumatic heart disease, Kawasaki disease or a coronary aneurysm – a localised enlargement that causes the diameter of a section of artery to swell to more than 1.5 times the size of adjacent segments.
According to Dr Kraisorn, some infants and children with mild heart defects may exhibit few or no symptoms and so may not need treatment. Severe or complex defects that will require medication or surgery can give rise to symptoms such as shortness of breath, rapid heartbeat, sweating, fatigue or a bluish tint to the lips, skin and fingernails.
Some infants with heart problem may not develop at a normal pace. “They may be smaller or thinner than other toddlers of the same age and they may start sitting up and walking much later than their peers,” Dr Kraisorn said.
“In many children, a hole in the heart will close by itself. A tiny one may not need an operation. Patients may need occasional check-ups with a cardiologist as they grow to adulthood.”
Less serious heart defects can be remedied with medication or by inserting a catheter. Surgery may be the last resort for babies or toddlers with complex and/or severe defects.
“In many cases, a single operation can repair the defect completely. But some patients may require several surgeries over a period of time to fix the defect,” the cardiologist explained.
“The treatment options available to a child will depend on the types of defects and their severity. Factors also include the child’s age, size and general state of health.”
Each year, between 3,500 and 4,000 children in Thailand with congenital heart defects need an operation to prevent premature death or major physical underdevelopment. about 20% of them die within one year of their birth.
Due to limitations on medical personnel and facilities, state-run hospitals are only able to perform surgery on 2,000 to 2,500 of these cases. That means that 1,500 to 2,000 very sick children have to go on a waiting list.
“Samitivej’s Fund for new Life was created to help children in need,” said Dr Chanika Tuchinda, chairman of Samitivej Srinakarin Children’s Hospital and president of the Samitivej Heart Fund. “The paediatric heart project provides a good opportunity for needy children [both Thai and foreign].”
Launched in 2009, the project is a collaboration between Samitivej Hospital and the Cardiac Children Foundation of Thailand. It has set itself a short-term target of helping 60 underprivileged babies and children. That number was chosen to mark the 60th wedding anniversary of Their Majesties the King and Queen. So far 17 youngsters have been operated on, with a 100% success rate.
“To successfully perform an operation on a young patient with congenital heart defects, we require a team of well-trained medical personnel and an anaesthetist and good staff on the ward, plus all the necessary equipment and facilities. We think we have the ability to do that,” said Dr Surangkana Techapaitoon, deputy director of Samitivej Srinakarin Hospital.
Advances in diagnostic and surgical techniques mean that children with cardiac problems have a much better chance of survival than ever before. “Almost every single child with a congenital heart defect who undergoes surgery can grow to adulthood and lead an active life,” said Dr Kraisorn. “Many complex congenital heart defects can be cured, but they may need routine or special medical care.
“Most children with heart defects run a high risk of contracting bacterial endocarditis. some may need antibiotics before medical or dental procedures that might allow bacteria to enter their bloodstream.
“Regular brushing and flossing as well as visiting a dentist every six months are highly recommended.”
You can help children with congenital heart defects by making a donation to the Fund for new Life. the account details are as follows:
Bank: Thai Military Bank Account name: Wachira Medical College Foundation under the Royal Patronage of HRH Crown Prince Maha Vajiralongkorn for Samitivej’s Fund for new Life (Paediatric Heart) Savings account no: 196-2-08745-6.
Donations can also be made in person at Samitivej Sukhumvit Hospital, Samitivej Srinakarin Hospital and Samitivej Sriracha Hospital.
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