“Pediatric Cardiology Goes Sea Change”

Dr Shreesha Maiya,
Consultant, Pediatric Cardiology,
Narayana Hrudayalaya Multispecialty Hospital, Bangalore

Dr Shreesha speaks to Sharmila Das, ENN about the intricacy of handling pediatric cardiology

How do you find the role of Pediatric Cardiology in delivering improved patient care?
Congenital heart defects are seen in 8 to 10 children out of 1000 live-born children. Most importantly almost all of them can be treated if diagnosed early and majority of them would have a normal life in future. Hence it is important to diagnose children early and refer them to a centre where interventions can be offered when necessary.

What are the changes you have noticed in this domain over the years?
Over the last 10-15 years, pediatric cardiology has taken a big leap in India. This is mainly due to the affordability and various schemes organised by the Government and charitable trusts. Hence there has been a major shift towards early referral from the pediatricians, understanding that these children have excellent prognosis. Technology has also advanced over the years .Children who earlier needed open heart surgeries can get interventions with key-hole surgeries that significantly reduces hospital stay. Fetal chocardiography has also made huge impact in the early diagnosis of children. Fetal cardiology has improved scope of early diagnosis and referral and considerably added to better survival.

Do you think these changes will improve the healthcare scenario in general and pediatric cardiology in particular?
Diagnosis and treatment is the key. With improved education and understanding both in medical fraternity and public, we could change pediatric cardiology scenario in India. Most important factor had always been patient affordability. There are Government schemes in few states like Karnataka, Andhra Pradesh etc which has made significant impact. If this could be extended to other states,
then we will see huge reduction in morbidity and mortality rates.

In dealing with high volume of infant mortality rate, do you think improved Pediatric Cardiology can contribute to improve the situation a bit?
The causes for infant mortality rate due to congenital heart diseases contribute to a small percentage. But, improvements in pediatric cardiology care definitely lessen the burden of infant mortality. It will also contribute towards reducing the co-morbidity like multiple hospitalisations for pneumonia in patient with congenital heart diseases.

What are the new equipments/ technologies Narayana Hrudalaya has introduced lately in Pediatric Cardiology?
On the diagnosis aspect, advances in fetal echocardiography, 3D echocardiography, MRI and high resolution CT have provided tremendous insight into the nature of congenital heart problems. Interventional cardiology with devices and stents has reduced the need for open heart surgeries in many children. State-of-the-art machinery in anesthesia, improved by-pass technologies and use of trans-esophageal echocardiography has reduced the risks of surgeries and interventional procedures and has improved overall patient care. Advent of minimally invasive surgeries has also reduced the duration of hospital stay and has improved cosmetic outcome. Newer medications and equipment like ECMO leads to better care in Intensive care units. All of these collectively have made huge impact in reducing morbidity and mortality rates associated with cardiac interventions.

Narayana Hrudayalaya “ Achievements
The Bangalore cardiac unit of Narayana Hrudayalaya is one of the worlds largest pediatric heart hospitals. It is the brainchild of the renowned cardiac surgeon, Dr Devi Shetty. Narayana Hrudayalaya also receives patients from outside India. Narayana Hrudayalaya was started in the year 2000 by Dr Devi Shetty under the aegis of the Asian Heart Foundation (AHF). The flagship hospitals of the group are located in the cities of Bengaluru and Kolkata. They are both multi-specialty hospitals which cater to a wide variety of illnesses and diseases. Narayana  rudayalaya has innovated with the concept of health city which means Onepoint for all Healthcare needs. Narayana Hrudayalaya Health City, Bengaluru, is a conglomeration of hospitals in one campus.Apart from cardiology, the hospital also offers treatments in the area of Neurosurgery, Pediatrics, Neurology, Gastroenterology, General Surgery, Dental, Nephrology, Urology, Transplants, Nuclear Medicine, Medical Imaging and Radiology. It also houses a Blood bank and Laboratory. With the help of ISRO, Narayana Hrudayalaya has pioneered some of the aspects of Telemedicine. Narayana Hrudayalaya Group is one of Indias leading and fastest growing multi-specialty chains in India. With total bed strength of 5,700 beds, it is spread across 13 Indian cities. The Flagship Hospital at NH Health City, Bangalore has Indias largest Bone Marrow Transplant Unit and Dialysis with tertiary care expertise in Liver, Kidney and Heart transplants.

What are the top five challenges of a pediatric cardiologist? How do you deal with them?
Early diagnosis: Early diagnosis is the key; educating medical fraternity regarding congenital heart diseases will lead to early referral and appropriate management.
Delivering good quality affordable care: This is achieved by team work and multi-displinary approach with appropriate use of technologies.
Patient education and supporting families with congenital heart diseases: Creating empathy with patient /parents and educating them about the nature of problems and interventions should be a collective effort. Keeping up with new advancements and technologies so that the patient would benefit from state-ofthe- art treatment. Reaching out to public and creating awareness regarding congenital heart disease is an ongoing challenge. Appropriate referral systems need to be strengthened so that patient does not get lost in the transit and follow up care.

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