Half of the newborns who would need surgery to correct congenital heart disease were left without care in Brazil, according to the Society of Cardiologists of the State of Sao Paulo (Socesp). The entity, however, estimates that percentage may have risen to 70% during the covid-19 pandemic.
According to the World Health Organization (WHO), about 130 million children worldwide have some congenital heart disease.
According to the Ministry of Health, there are ten cases per thousand live births in Brazil, ie one child for every 100 births has cardiovascular malformations. according to site Fundação Oswaldo Cruz (Fiocruz), is equivalent to about 30 thousand children with congenital heart disease per year, of which 6% die before the age of 1 year. After birth, severe forms of the disease can be responsible for 30% of deaths in the neonatal period. Last Sunday (12) marked the Day of Congenital Heart Disease.
Medical Director of the NGO Pro Criança Cardíaco, Isabela Rangel, explained that congenital heart disease is a malformation or abnormality in the structure or cardiorespiratory function of the heart. “This happens during fetal life. [da criança]. ”
Isabella said that there is no definite cause of congenital heart disease, which occurs due to the interaction of genetic and environmental factors. “Genetics, we say when there are patients with other syndromes, which may be associated with heart malformations. Ecologically, when mothers used some kind of medicine or medicine, they had diseases such as lupus, diabetes or some viruses that the pregnant woman infected and can cause intracardiac malformation. The doctor points out that it is necessary to be aware of the history of heart disease in previous pregnancies and genetic inheritance.
Genetic syndromes are also factors associated with intracardiac malformation, such as Down syndrome, in which one percent of patients may have an atrioventricular septal defect, among other heart diseases. The young age of the mother is also considered a risk factor for congenital heart disease.
Isabela Rangel emphasized that there is no prevention, but said that every woman who wants to get pregnant must know what her health condition is, so that her doctor can monitor and advise medications and medications that she should not use during pregnancy. A woman must maintain a healthy diet and habits, avoid alcohol and smoking, which can cause changes in fetal development.
It is also important to check the vaccination schedule and see if vaccinations are needed before pregnancy.
Isabela emphasized the importance of healthy eating habits, referring to recent research according to which enrichment of some foods with folic acid is associated with a reduction in the rate of congenital heart disease.
The diagnosis of congenital heart disease is made while the child is still in the mother’s womb. Isabella said that the non-governmental organization under her direction is trying to make all experts who deal with pregnant women aware of the importance of morphological examination and fetal echocardiogram (ecofetal) which can detect congenital heart diseases.
Fetal echocardiography is a method that can identify structural lesions before birth and, in general, should be performed between the 24th and 28th week of gestation. “And if you have heart disease that needs intervention in the first days of life, it is essential for the baby’s prognosis. All the more so when it is known that this pregnant woman has a fetus with heart disease, and as it is a critical and complex heart disease, care is taken to get the baby in a health unit that has an intensive care unit. [unidade de terapia intensiva]in which the baby has an echo after birth, where there are resources, that the baby is treated with full care. ”
Not all babies who have congenital heart disease at birth need it. It depends on the intracardiac pathology. Interventions will vary depending on pathology and severity. Isabella pointed out that some babies will be operated on much later, while others, with more severe heart disease, will have to intervene in the neonatal period.
Some heart diseases can be treated with hemodynamics. Instead of open chest surgery, the child may undergo a less invasive procedure called therapeutic cardiac catheterization. “This is an example. There are some heart diseases that can be treated with therapeutic catheterization. It’s invasive, but much less than heart surgery. ” Early diagnosis is necessary, especially in the most severe heart diseases, Isabella said.
The doctor pointed out that one of the obstacles that delays the diagnosis is the lack of information from families about the existence of heart disease in children. “Pediatric monitoring of babies is essential, because during routine consultations, any change that indicates heart disease can be identified; so the pediatrician refers them to a specialized center. “
The focus of the Pro Criança Cardíaco project is caring for needy children and adolescents with heart disease. The project accepts children on an outpatient basis and, depending on whether the case is surgical, they can be referred to the Pro Criança Jutta Batista Pediatric Hospital, an NGO partner. The same happens when there is a diagnosis for therapeutic catheterization. “Every invasive procedure is done at the hospital level.”
Pro Criança Cardíaco monitors children from childhood to adulthood, from the age of 18, and offers a multidisciplinary care team that includes medicines, cardiologists, nutritionists, social workers, psychologists and dentists, “because patients cannot have an infectious focus in their mouth” .
The Pró Criança Cardíaco project is not a hospital; is a non-profit medical institution founded in 1996 by cardiologist Rosa Celia, which provides free care to children and adolescents with congenital heart disease. In its 25 years of existence, it has helped 15,100 children and adolescents with heart problems, performed more than 33,000 cardiac consultations and sent 1,659,000 invasive procedures, cardiac surgery and catheterization to a partner hospital.
At its headquarters in Rio de Janeiro, the NGO helps about 160 children a month in the clinic, who undergo a clinical evaluation, electrocardiogram, echocardiogram and 24-hour holter. Other outpatient examinations, such as hematological assessment and tomography, and invasive procedures, including heart surgery and catheterization, are performed at Pro Criança Jutta Batista Pediatric Hospital.
After his discharge from the hospital, he is scheduled to return to the clinic to continue his treatment. Throughout the process, the team that monitors the patient is the same and provides all the support.
To apply for the first service, you need to call (21) 3239-4500, Monday to Friday, from 8 am to 6 pm. Pro Criança Cardíaco currently has 16 vacancies for first care. Vacancies are filled according to availability or urgency as previously assessed by the medical team.