in Cuba of children with cardiopathies (1986-1996)
Authors:
Ramón Casanova Arzola, M.D. ,
Eugenio Selman Houssein Sosa, M.D.1
Contributors: Carlos García Morajón, M.D.;
Paulino Nuñez Casteñon, M.D.;
Andrés Benavides, M.D.;
Felipe Cárdenas González, M.D.;
Carlos Dotres Martínez, M.D.;
José M. Lambert Maresma, M.D.;
Vicente López Benitez, M.D.;
Francisco Caballes García, M.D.;
Luis Córdoba Vargas, M.D.;
Otto Machado Fernández, M.D.;
Francisco Valdés Lazo, M.D.1 ;
Herminia Palenzuela López, M.D.1
ABSTRACT: More than 1,000 children (8 out of every 1,000 live births) are born annually in Cuba with congenital cardiopathies, while 20% to 40% of these cases are classified as very severe. With the opening of the William Soler Cardiocenter, the national program for the care of children with heart disease was established as part of the existing Comprehensive Care Program for Children. During the past 10 years (1986-1996), a total of 3,956 operations have been performed on children with congenital heart disease, in 60% of the cases with the use of extracorporeal circulation. The Pediatric Heart Network reaches out to the primary and secondary health care levels, which has resulted in a reduction of mortality rates in cases under one year of age from 3.3 per 1,000 live births in 1983 to 1.03 per live births in 1995.
Great importance is paid in Cuba to health programs,
with special emphasis on care for children and pregnant women (1). After a significant drop in mortality due to disorders such as diarrhea, infectious diseases and malnutrition(2); chronic diseases, cancer, accidents and
congenital malformations have gained in importance as major causes of death. Half of the demise attributed to congenital malformations are due to heart disease (3). The incidence of congenital
cardiopathies in Cuba is similar to the international average of 8 per 1,000 live births (4,5). Consequently, given the current birth rate, in Cuba more than 1,000 children are born each year with these disorders.
Approximately 20% to 40% of these children (almost 2 out of every 1,000 live births) present severe cardiopathies with a mortality rate during the first month of up to 50%. Most of deaths due to congenital
cardiovascular malformations occur during the first six months (5). It became clear that a national program for the care of children with cardiopathies was needed in order to
improve their quality of life and contribute to an ultimate drop in mortality. This program was included in the Comprehensive Care Program for Children and became a reality with the
inauguration of Havana's William Soler Cardiocenter in August 1986, as the National Reference Center for Children's Cardiovascular Surgery. During the Center's past ten years of existence (October 27, 1986 to
December 31, 1996) approximately 14,000 patients were admitted and 3,956 operations performed on children with congenital cardiopathies and other heart disorders; in which 60% have required the use of extracorporeal circulation.
The work of the Pediatric Heart Network encompasses the primary and secondary health care levels and is headed by a cardio-pediatrician in each of the 14 provinces in the country,
including the special municipality of the Isle of Youth. These health professionals work in coordination with the pediatric and gynecological-obstetric hospitals, neonatology services
and intensive care units, cardiopediatric wards, polyclinics, family doctors and nurses, social workers, etc. Relations with the different levels have expanded in order to guarantee
continuity in the management of patients during each stage of treatment. A plan has been drawn up for training and up-grading of the personnel linked to this activity, including
pediatricians, cardiologists, anatomical-pathologists and geneticists, which will also ensure a broader coverage. To this end, several national and provincial courses have been offered,
together with internship programs at the William Soler Cardiocenter and in other facilities, and meetings of the Network and scientific events have been held.
Participation of the primary health care level is crucial in the control and prophylaxis of rheumatic fever and support for the prenatal detection program for congenital heart disease,
providing genetic information and counseling for parents. This is achieved by means of a prenatal eccocardiograph preformed during week 20 of pregnancy, in any of the country's
gynecological-obstetric hospitals or at the National or Provincial Reference Centers if necessary. The prenatal detection program for congenital cardiopathies has been generalized and functions throughout the country (7).
The primary health care network offers ambulatory care to these children, with a special emphasis on their rehabilitation, prophylaxis of complications and health promotion.
This program takes aim at a health problem, but also generates social welfare and offers families a sense of security; especially if one considers that mortality due to this cause in
children under one year of age dropped from 3.3 per 1,000 live births before 1983 to 1.03 in 1995. Another important element to be kept in mind is the downward trend in the incidence of
congenital cardiopathies as a cause of infant mortality due to congenital malformations (8). In children under 15 years of age, mortality due to cardiopathies dropped from 21.4 per
100,000 (1980), to 0.6 in 1996. In the 1 to19-year age group the figure dropped from 16.2 per 100,000 to 0.1 during the same period (8). The most advanced surgical techniques have been introduced for the treatment of more
complex heart disorders. The use of catheters has been developed with great success since 1987 (515 patients treated). The Cardiac Rehabilitation Program for Children, which has also been successful,
includes more than 800 children who have undergone surgery in the Cardiocenter. Scientific activities, teaching and research have been given priority and representatives from
the Cardiocenter have attended international and national congresses and events in this field. Scientific exchange with specialists and scientists from other cardiology and children's
cardiovascular surgical centers has been very active. One of the results of the Program has been greater motivation and renewed interest in this theme among the professionals involved.
References
1. Cuba, Ministry of Public Health (MINSAP). Program for Development by the year 2000: Pediatrics, Havana, 1988.
2. Cuba, Ministry of Public Health (MINSAP). Yearbook of the Statistics Department, MINSAP, Havana, 1993.
3. Report from the meeting of the National Pediatric Heart Network. William Soler Pediatric Hospital. (photocopy)
4. Adams FH, Emmanoulides GC, Riemenschneider TA. Most Heart Disease in Infants, Children and Adolescent. Fourth Ed. Baltimore, Williams and Williams; 1988.
5. Anderson R, Macartney F, Shenebourne E, Tynan M. Pediatric Cardiology. New York: Churchill Livingstone; 1987.
6. Reyes Vega. Morbi-Mortality due to Congenital Heart Disease: A study performed in Cuban provinces. This paper was presented at the Scientific Council of the William Soler Pediatric Hospital, Havana, 1992.
7. Savio A, Oliva J. Fetal Echocardiography: Evaluation and Results Obtained from a National Program 1989-1991. Rev Cub Ped, 1995.
8. Valdés Lazo F. National Mother and Child Division and Statistics Department of the Cuban Ministry of Public Health, 1995.
