Surgery for CHD in Malaysia-setting standards for lower and middle-income countries

The surgery for congenital heart diseases in Malaysia started in 1992 under the purview of the adult cardiac unit within the framework of the General Hospital. This unit catered for the whole country within its landscape of limited manpower and inadequate infrastructures. Recognizing the significant burden of heart diseases, the Paediatric and Congenital Heart Centre (PCHC) at the National Heart Institute in Kuala Lumpur was established in 2012. Initially, PCHC stood as the sole hospital undertaking congenital heart surgeries in Malaysia. However, in recent years, hospitals affiliated with the Ministry of Health and University Hospitals have begun establishing their own units to address the escalating burden of congenital heart disease. Nevertheless, PCHC remains pivotal, performing 800 to 900 open heart surgeries annually, comprising over half of Malaysia's yearly caseload. Notably, a majority of these patients receive funding from the government. Despite the increased surgical capacity, challenges persist, leading to disparities in access to care for many patients in Malaysia. This article delves into the problems and challenges faced by the Paediatric and Congenital Heart Centre in providing cardiac surgeries within a resource-limited setting.