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Congenital heart disease in Papua New Guinean children
N Tefuarani1, R Hawker, J Vince
1Clinical Sciences Division, School of Medicine & Health Sciences, University of Papua New Guinea, PO Box 5623, Boroko, Papua New Guinea.
Insights
This study evaluated surgical management for congenital heart disease in children from Papua New Guinea (PNG). The program was successful for a small group, with acceptable outcomes for the era.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Global Health
Background:
- Congenital heart disease (CHD) poses significant challenges in low-resource settings.
- Surgical management programs for CHD in developing nations require critical analysis.
- Papua New Guinea (PNG) has limited access to specialized pediatric cardiac care.
Purpose of the Study:
- To critically analyze the surgical management program for children with congenital heart disease in PNG.
- To document the patterns, management, and short-term outcomes of PNG children undergoing cardiac surgery in Australia.
- To assess the success and limitations of this international referral program.
Main Methods:
- Retrospective hospital record analysis of 165 children referred from PNG (1978-1994).
- Data collected included demographics, clinical presentation, diagnostic workup (echocardiography, cardiac catheterization), surgical procedures, and outcomes.
- Analysis focused on common CHD types, surgical approaches, complications, and mortality.
Main Results:
- Ventricular septal defect (34%), tetralogy of Fallot (23%), and patent ductus arteriosus (16.4%) were the most common defects.
- 133 children (81%) underwent surgery, predominantly open-heart procedures (75%).
- The overall mortality rate was 6%, considered acceptable for the period.
Conclusions:
- The surgical management program was successful for a subset of PNG children with CHD.
- Certain complex lesions were under-represented, indicating potential gaps in diagnosis or referral.
- The program demonstrated feasibility and acceptable outcomes in a resource-limited context during that era.
Abstract:
The aim of the study was to analyse critically the programme for surgical management of children in Papua New Guinea (PNG) with congenital heart disease. A hospital record-based analysis was undertaken to document the pattern, management and short-term outcome of surgery in PNG children referred with a diagnosis of congenital heart disease to the Royal Alexandra Hospital for Children in Sydney, Australia. On admission, physical examination, chest radiogram, electrocardiogram, cross-sectional echocardiogram and, in most cases, cardiac catheterization were performed. Of the 170 children referred over the 17-year period, 1978-1994, 165 were confirmed to have congenital heart disease and were included in the study. Their ages ranged from 2 months to 16 years (median 5.5) and the male to female ratio was 1:1. One-sixth had delayed milestones and one-fifth long-term wasting. A large number were tachypnoeic, in heart failure or had pulmonary hypertension on admission. Ventricular septal defect, 34%, tetralogy of Fallot, 23%, and patent ductus arteriosus, 16.4%, were the predominant defects. lesions such as aortic stenosis, coarctation of the aorta and transposition of the great arteries are under-represented. Altogether, 133 children (81%) had surgery; 75% were open- and 25% closed-heart operations. The complications were unremarkable and the mortality rate (6%) acceptable for the era. The programme was therefore very successful for a small proportion of children born in PNG with congenital heart disease.
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