Successful introduction of interventional catheterisation and other paediatric cardiology services in a developing country.
BACKGROUND
Providing care for children with cardiac disease remains a challenge in developing countries.


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.
Cardiovascular Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan. tomitah@med.showa-u.ac.jp
Hideshi
H
Tomita
Noriyuki
N
Haneda
Takashi
T
Higaki
Koichi
K
Kataoka
D000293:Adolescent; D006328:Cardiac Catheterization; D002309:Cardiology / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D004452:Echocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D008986:Mongolia / Q000453:epidemiology; D010372:Pediatrics / Q000379:methods*