Congenital heart diseases are rapidly increasing among children in Pakistan.
In this regard, Assistant Professor and Pediatric Cardiologist at NICVD, Dr Aaliya Kamal Ahsan, said that around 40,000 to 60,000 children are born with heart diseases every year in Pakistan, with the most common condition being Tetralogy of Fallot (TOF), in which the heart structure is affected in four places.
She said that 10 to 12 percent, or around 4,000 to 7,000 children, are TOF patients. If this disease is not diagnosed and surgically treated on time, the child’s life can be at risk, while cousin marriages further increase the chances of this condition.
She stated that NICVD performs two TOF open heart surgeries and two shunts (closed heart surgeries) daily, while thousands of surgeries are performed annually. TOF is not a medical but a surgical disease. Its four components include misalignment of pulmonary valves, overriding of the aorta, VSD, hypertrophy and holes in the heart. This disease can only be treated through surgery, and medical treatment is not effective.
Dr Aaliya Kamal Ahsan said that if surgery is not performed on time, the mortality rate within one year can reach up to 40 percent, but if surgery is done, the risk of death becomes only 1 percent in the next forty years, showing a clear improvement in quality of life. For NICVD pediatric surgeons, this is considered one of the most common and routine surgeries, although the spectrum of the disease is very wide.
She said that TOF does not appear the same in every child. Some are diagnosed at four months of age, some turn blue in the morning, while bathing or crying, and some are blue at birth, which is the severe type known as TOF with pulmonary atresia. In some children, blueness does not appear; such cases are called pink TOF, but they develop breathing issues over time.
Dr Aaliya said that pulmonary valves in TOF patients often start leaking, but the rate is lower among their surgeons compared to international statistics, which NICVD has also researched. Valve leakage is categorized into mild, moderate and severe. If leakage becomes severe, the right ventricle begins to fail. Valve replacement becomes necessary, which can be done either through a cannula-based procedure or through surgical valve replacement. This facility is available at SIUT.
She said that if TOF is diagnosed immediately after birth, surgery should be done early, but globally, surgery is usually performed between six to nine months of age because valves in smaller babies are narrow and putting patches can affect the valves. However, the exact timing of surgery depends on the severity of each child’s condition.
Dr Aaliya said that genetic factors play a significant role in this disease. Cousin marriages in society increase its risk. If the mother has TOF, there is a ten percent chance that the child may have it. Similarly, if the father or siblings have it, the risk increases. However, new mutations can also occur, meaning the disease may appear in a child even when no one in the family has it.
She said that globally, 1 in every 100 children is born with congenital heart disease, but in Asia, the rate has increased to 8 to 9.3 percent, and in some regions up to 12 percent. Among all these diseases, TOF is the most common. For accurate diagnosis, a good ECG, X-ray and echocardiogram are essential. If the imaging specialist is highly skilled, more than 90 percent of issues can be detected through echo alone, enabling timely treatment and surgical decisions.
