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Successful introduction of interventional catheterisation and other paediatric cardiology services in a developing
Hideshi Tomita1, Noriyuki Haneda, Takashi Higaki
1Cardiovascular Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan. tomitah@med.showa-u.ac.jp
Insights
Catheter interventions offer a viable alternative to surgery for children with congenital heart disease in developing nations. This study highlights successful transcatheter treatments in Mongolia, improving care for pediatric cardiac patients.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Global Health
Background:
- Pediatric cardiac care is challenging in developing countries.
- Limited resources necessitate focused, cost-effective interventions.
- A collaborative effort has provided specialized care in Mongolia since 2001.
Purpose of the Study:
- To evaluate the effectiveness of pediatric cardiac catheterization in Mongolia.
- To assess transcatheter interventions for congenital heart diseases.
- To improve screening and treatment accessibility in resource-limited settings.
Main Methods:
- Diagnostic echocardiography and cardiac catheterization performed.
- Transcatheter closure of persistent arterial duct (PAD) using coils and duct occluders.
- Balloon dilation for valvar pulmonary stenosis and aortic coarctation.
Main Results:
- Over 1200 echocardiograms and 255 catheter interventions completed by 2011.
- Successful closure of 224 PAD cases, with low complication rates.
- Effective treatment for pulmonary stenosis and aortic coarctation in pediatric patients.
Conclusions:
- Transcatheter procedures are an attractive alternative to surgery for simple congenital heart diseases in developing countries.
- Duct occluders expanded PAD treatment options in Mongolia, reducing costs.
- This approach enhances pediatric cardiac care accessibility in resource-limited environments.
Background:
Providing care for children with cardiac disease remains a challenge in developing countries.
Materials And Methods:
Since 2001, a team of paediatric cardiologists has been visiting Mongolia to perform children's cardiac catheterisation, as well as screening children for cardiac disease. Considering the limited medical resources, as well as cost, risk, and benefit, we focused our activities on diagnostic consultation by echocardiography, transcatheter closure of persistent arterial duct, balloon dilation of valvar pulmonary stenosis and aortic coarctation, and diagnostic catheterisation.
Results:
Up to 2011, we have completed echocardiography in 1200 patients; diagnostic catheterisations in 59 patients; and catheter interventions in 255 patients, including 224 for persistent arterial duct, 23 for valvar pulmonary stenosis, 6 for aortic coarctation, and a few others. We have visited 14 rural areas to screen for children's cardiac diseases. A total of 131 persistent ducts were closed with coils and a further 93 with a duct occluder. Migration of the coil or occluder to the pulmonary artery occurred once for each device. Pulmonary valvuloplasty was successful in 23 patients and a coarctation was effectively dilated in six patients.
Conclusions:
The limited healthcare resources in developing countries such as Mongolia make catheter interventional procedures an attractive alternative to surgery in treating children with simple but critical congenital heart diseases. Introduction of the duct occluder extended the application of transcatheter occlusion of persistent arterial duct in Mongolia to larger vessels and avoided the expense of coil occlusion using multiple coils.
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