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Doctors from paediatric cardiology attending a

Paediatric Congenital Heart Conditions Support

Group Party.

W

hat is Paediatric Cardiology?

Paediatric cardiology is a unique

subspecialty; while many pa-

tients are young, investigations and

examinations related to heart conditions

are similar to adult cardiology. Thus, it

encompasses both major disciplines of

paediatrics and cardiology. While most

patients have heart defects since birth,

there are now more heart conditions

that develop after birth, including heart

rhythm disorders and heart diseases

affecting the heart muscles or entire body.

Diagnosis may begin as early as the

fetal stage, where heart anomalies can

be detected through a heart ultrasound.

This allows for a team-based approach

involving the obstetrician (a doctor

specialising in pregnancy and childbirth),

neonatologist (a doctor specialising in

the medical care of newborn infants)

and surgeon.

The use of early fetal

detection of complex heart

disease to early life-saving

surgery and intensive neona-

tal care has enabled patients

to survive and thrive in child-

hood and into adult life.

Seamless Transition to Adult

Cardiology

When a paediatric heart patient enters

adulthood, he is referred to the adult

congenital heart disease team. The

management of the kid with heart disease

is therefore seamless and continuous,

and NUHCS is a place that affords such

an opportunity.

Some patients who have been operated

early on in life may have to undertake

more surgeries when they get older

as pulmonary valve regurgitation

1

or

degeneration of their conduits

2

occur.

However, such

repeated open-heart

surgeries not only increase the

risk of complications but they

are also psychologically demand-

ing for patients and their families.

There is now an alternative treatment

option available. Without requiring open-

heart surgery, it treats narrowed or leaking

pulmonary valve conduits between the

pumping right side of the heart and

lungs. A specially designed catheter (thin

hollow tube) is inserted from a vein to the

heart to replace the old valve with a new

one, thus helping the heart to pump blood

properly

(see figure 1)

.

Melody Transcatheter Pulmonary

Valve (TPV) Therapy

The Melody TPV Therapy has been

started since 2000 and has undergone

rigorous scienti c scrutiny before becom-

ing approved by the US Food and Drug

Administation (FDA), in which the FDA has

decided that its bene ts outweigh

potential risks. It is now a recommended

therapy for selected patients as it has

shown to be safe and effective in restor-

ing the function and increasing the

lifespan of pulmonary valve conduits

3

or

homografts

4

. In 2016, NUHCS success-

fully performed our rst two Melody

TPV Therapy procedures jointly with

the Division of Paediatric Cardiology,

National University Hospital.

One of the procedures involved treating

a congenital heart defect called Tetralo-

gy of Fallot without open heart surgery,

a rst in Singapore

(featured in The Straits Times on 22 November 2016).

This showcases the strength and depth

of collaboration between our paediatric

and adult congenital teams. Both patients

have been discharged and are doing well.

We are immensely grateful to

The Heart Fund donors for help-

ing our patients defray the high

cost of therapy

and are committed

to scaling greater heights in patient

outcome and experience.•

NUHCS and NUH’s Division of Paediatric Cardiology were featured in The Straits Times on 22 November

2016 for treating Tetralogy of Fallot without open heart surgery for the first time in Singapore.

NUHCS PULSE

Issue 28

06