On Thursday (Dec. 28), a beacon of medical expertise illuminated Universitas Gadjah Mada (UGM) as esteemed cardiologist Dr. Lucia Kris Dinarti, MD, assumed the prestigious mantle of professor in vascular medicine cardiology.
In her inaugural address, “Pulmonary Arterial Hypertension as a Complication of Congenital Heart Disease: Comprehensive Management from Prevention to Rehabilitation,” Professor Dinarti underscored the pivotal importance of early detection in mitigating the menace of heart diseases, particularly congenital heart disease (CHD).
In a world where heart disease casts a long, ominous shadow, holding the top spot in the global roster of causes of death and disability, Professor Dinarti revealed alarming statistics.
A WHO report from 2011 painted a grim picture, with over 17 million succumbing to heart disease in 2008, over 3 million of them before the tender age of 60.
Distinguishing between acquired and congenital heart disease, Professor Dinarti explained the roots of heart ailments.
Acquired heart diseases stemming from environmental and lifestyle factors post-birth include coronary heart disease, valvular heart disease, and heart failure. In contrast, congenital heart disease emerges from anomalies during fetal development, persisting into postnatal life.
Professor Dinarti shed light on pulmonary arterial hypertension (PAH) as a potent consequence of CHD.
Pulmonary hypertension (PH), marked by increased pressure in pulmonary circulation due to vascular remodeling and inflammation, is a lurking threat.
The absence of a robust early detection system in Indonesia compounds the challenge, leading to underdiagnoses of children with mild complaints.
Early detection of health issues in children does not specifically identify congenital heart abnormalities. In contrast, in developed countries like Japan, early detection of CHD has been carried out at various stages, starting from the fetal period, infancy, childhood, and school age.
“Implementing these step-by-step early detection methods allows CHD to be identified early before more severe clinical manifestations appear, allowing for corrective action. In Japan, the success of this step-by-step early detection has drastically reduced the incidence of CHD in adulthood,” she said.
Despite a national program adopting pulse oximetry for critical CHD detection in newborns, systematic early detection of CHD doesn’t permeate Indonesian healthcare practices. The absence of such screening becomes evident in the prevalence of CHD in adults, hinting at undetected cases in childhood.
Professor Dinarti has been steering the CHD and PH registry at the UGM Faculty of Medicine, Public Health, and Nursing and Dr. Sardjito Hospital since 2012. The registry, embracing 2,171 adult CHD patients as of Nov. 2023, spotlights a stark reality.
A majority of cases, including atrial septal defect (ASD), ventricular septal defect (VSD), patent ductus arteriosus (PDA), and primary ph (6%), grapple with mild to severe pulmonary arterial hypertension (PAH) and even formidable Eisenmenger syndrome at relatively young ages.
The gender dimension reveals that 76% of the registry’s populace are females, with 72% in their childbearing years.
As Professor Dinarti unraveled pregnancy data over the past five years at Dr. Sardjito Hospital, the impact of CHD on maternal health surfaced—CHD contributed 53% to all heart diseases during pregnancy.
“This data supports the fact that heart disease now plays a role as a cause of illness and death in pregnant women. Data at Dr. Sardjito Hospital shows that pregnant women with CHD are mostly ASD, the majority of whom already experience pulmonary hypertension,” she explained.
To reduce the prevalence of CHD in adults, preventive measures such as early detection of CHD in childhood through a simple, applicable, acceptable, and effective screening program are vital.
During childhood, specific symptoms and signs have not yet appeared, but with simple heart examination methods, abnormalities can be detected and followed by corrective actions, preventing complications in adulthood.
“Until now, CHD screening or early detection has not become a routine early detection program for children in Indonesia due to the lack of simple, applicable, and effective methods,” she said.
In the absence of simple, applicable, and effective screening methods, the prevalence of undetected CHD casts a long shadow over Indonesia.
The screening initiative, Professor Dinarti contends, should kick off at birth, extending through school-age, adolescents, prospective brides, and even pregnant women.
Yogyakarta, a torchbearer in the CHD screening realm, should spearhead a nationwide campaign with the central government addressing drug availability concerns to ensure equitable disease management.
Author: Gusti Grehenson
Photographer: Firsto