A Canada-based Nigerian adult congenital heart disease expert, Dr Enitan Majekodunmi, talks to WINIFRED OGBEBO on the practice of cardiology and the range of treatment available for children born with heart defects.

What are the different specialties of cardiology?

A cardiologist specializes in diseases affecting the heart and the blood vessels. So it’s not just the heart but also the blood vessels as well. There are lots of parts of cardiology that you can specialize in. So, even if you are a general cardiologist, you can pick a part of cardiology to specialize in. The heart works with electricity so the heart in its own way, has its own generator which generates electricity. Some people can have problem, with electricity in their hearts and those specialists who deal with that are called electro physiologists. We have people who deal with the arteries around the heart; the arteries that supply the heart itself. They are the conventional cardiologists. We have cardiologists who deal with imaging so they do take pictures of the heart with many different things. They can use echo machine, MRI machines, CT scanners and nuclear radiation machines to look at the lots of different ways that the heart works and the way the heart functions and its affected. There are cardiologists who specialize in able to support the heart. They look at hearts that are weak and hearts that are failing. They specialize in ways to try to keep the heart working. So we call them heart- failing specialists.

My particular specialty is called adult congenital heart disease. I deal with patients who have generally been born with a heart condition in childhood, who have usually had to have series of operations in childhood to deal with their heart condition and when they hit 18 and they become adults, then we take over their care and we look after them. It’s actually a very new specialty in cardiology because 30 years ago, patients who were born with heart disease didn’t survive. It’s only about 30 years ago that they started being able to operate on these children and were beginning to keep them alive. So 30 years ago, there were no adults really who survived childhood to become adults with diseases that they were born with unless they were very lucky and the diseases they had were very mild to begin with. But now, no matter how complex these children are in childhood, they are getting operation and they are all now growing up and becoming adults. Not only do they have the problems they had as a child, but they are getting the same problems as a normal adult get. So a new breed of cardiologist is now coming forward to look after these patients.



What predisposes a woman to give birth to a child with heart diseases?

There are a number of conditions that can predispose a woman to giving birth to a child with heart condition. One of them is rubella. It’s very important for women when they are pregnant to go for ante natal care and they should be checked for a lot of diseases that can be prevented; one of them being rubella.

Things like diabetics also predispose a woman to having a child with heart defect. A woman who has infection is also predisposed. To be honest, if a woman herself has congenital defect as well which she may or she may not know about, predisposes her to having a child with a heart defect as well.

In some developed countries like the UK and US, all pregnant women will get a scan when they are 20 weeks to look at the heart of the foetus; to see if its normal or abnormal. So in more than 90 per cent of cases, when a child has a congenital heart disease, they already know about it before the child is born. What that allows you to do is that it allows you to prepare. If you know that, when the child is born, you need to start on some certain medication so that the child can be well until he needs to have an operation.

When a woman is 38 weeks pregnant, there’s a plan in place until she delivers. Wherever hospital she goes, she’s placed on medication immediately the child is delivered and they can transfer the child to the cardiac centre where the operation will be done at a later stage. It could be two or three days later but at least, you know that the child is going to be well and stable until he comes to the cardiac centre.

In the general population alone, children with congenital heart defects are about one per cent of live births. So, one in every 100 women who deliver a child will give birth to a child with a heart condition. Luckily, most of those heart conditions are simple and do not usually cause the child a problem. There are

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