April 23, 2009
Surviving a broken heart
Four-year-old Dana is such an active child, her mother forgets she has a hole in her heart. POON CHIAN HUI finds out more about this heart condition
It is hard to tell that four-year-old Dana Fernandez has a heart defect. The little girl loves to run around like most children her age and ice cream is one of her favourite foods.
'She likes to climb and run,' said her mother, Mrs Dora Fernandez, 36.
'My husband and I were shocked when Dana was born with three holes in her heart as we have two older children who are fine,' said the secondary school teacher. The couple have two sons aged 10 and seven.
There is only one hole in Dana's heart now. The other two holes closed within the first year.
'The doctor said she may not need surgery if the last hole closes on its own as she gets older,' said Mrs Fernandez.
The remaining hole is an atrial septal defect, which means that the hole is in the wall between the upper heart chambers known as the atria.
Other than having to go for check-ups every three months or so, Dana's heart condition has not affected her greatly. She attends nursery school at St James' Church Kindergarten.
In fact, she behaves so much like a regular child that at times her family forgets she has a heart defect.
'We allow her to run around and she doesn't seem very tired,' said Mrs Fernandez. 'She also seems to be able to keep up with her brothers. Sometimes, we simply forget that she has a heart problem.'
Even when she remembers that fact, Mrs Fernandez prefers not to be overprotective of Dana. On the contrary, she encourages her daughter to be active.
'I don't protect her too much; I encourage her to do sports,' she said, adding that the doctor does not restrict Dana when it comes to sports activities.
Dana will be taking part in the Cold Storage Kids Run next month, her first running event. Although she is too young to realise that she will get a medal for participating in the non-competitive 700m event, she knows her efforts will be rewarded.
'Do you know what you are going to get after the run?' her mother asked. She replied with a hopeful look: 'Ice cream?'
Taking part in sports events helps Shaun feel like any other boy. The nine-year-old has a hole in his heart
It was probably the hardest news for a parent to receive. Nine years ago, Mrs Pamela Tan, now 42, was told by a doctor that her four-day-old infant son had three holes in his heart. He was five weeks premature.
'My husband and I were devastated by the news,' she said. Thankfully, two holes closed after 48 hours while the remaining hole, a ventricular septal defect - where the hole is located in the wall between the lower heart chambers called the ventricles - was not serious.
Surgery was also not necessary then.
'The doctor said we would have to wait till he is about 18 years old before we will know if surgery is required,' said Mrs Tan.
Now nine years old, Shaun is doing well. His condition has been very stable, said Mrs Tan, a housewife. However, she is cautious when it comes to permitting her only child to take part in sports.
'He likes to play soccer but it's too vigorous,' she said. 'I don't allow him to join the school soccer team as the doctor said he should not participate in competitive sports.'
Although Shaun is aware of his heart condition, the restrictions frustrate him at times. 'Sometimes, he throws tantrums and says things like, 'Why can't I do this? Go get the doctor to close the hole',' said Mrs Tan.
However, for the most part, the Primary 3 pupil at St Stephen's Primary School is a sensible child who understands his challenges. 'I know that I might faint if I take part in activities that are too vigorous,' he said, before adding cheekily, 'but I will ask many times and try to persuade my mum anyway.'
This never-say-die spirit paid off last year, when Shaun got his parents' consent to take part in his school's annual 1.5km mass run.
'He was very persuasive and persistent. He told me that the run was not a competitive one and that it was less than 2km,' said Mrs Tan with a laugh. 'That day, he was very exhausted but managed to push himself to the finishing line.'
More importantly, completing the run helped Shaun gain more confidence in his physical ability.
On May 24, he will take part in his second run, the Cold Storage Kids Run, which will be held at the Padang. He will be participating in the 700m non-competitive run.
'Taking part in runs like this makes me feel like an ordinary person. I can do the same things as other kids,' he said with a big grin.
WHAT IS A HOLE IN THE HEART?
A hole in the heart is the common name given to congenital heart defects in the wall of the heart.
It is a hole in the wall that separates the right and left chambers of the heart, said Dr Tan Teng Hong, senior consultant at the Paediatric Cardiology Service, KK Women's and Children's Hospital (KKH).
'A hole in the heart can occur solitarily or as part of a more complex heart defect," he said. 'Those with small holes may show no symptoms at all, while large holes may present very early within the first few months after birth."
Symptoms include shortness of breath and exhaustion. Some babies may also exhibit poor growth and do not feed well.
The heart is built like a container with four chambers. The right chambers collect and redirect deoxygenated blood to the lungs, while the left receive freshly oxygenated blood and pump it to the rest of the body.
When there is a hole between the chambers, leaks occur. Each time the heart pumps, some oxygenated blood gets shunted into the chambers containing deoxygenated blood.
This backflow creates additional flow and pressure on the lungs, said Dr Tan. If left untreated, this may lead to pulmonary hypertension.
There are two common types of holes. An atrial septal defect is a hole in the wall that separates the two upper chambers of the heart, the atria. Meanwhile, a ventricular septal defect is a hole in the wall between the lower chambers, or ventricles. Ventricular holes can either be in the muscular part or in the membranous part of the heart.
In Singapore, congenital heart defects occur in eight out of 1,000 live births, according to KKH. Of this number, about 20 per cent suffer from ventricular septal defects, while about 6 to 10 per cent have atrial septal defects. Some are born with more than one hole in the heart.
Holes in the heart are diagnosed with a stethoscope which the doctor uses to listen for heart murmurs, said Dr Tan. A heart murmur is a sound made by the flow of blood through the hole every time the heart beats.
'We may perform an echocardiogram, which is an ultrasound of the heart, to observe the flow of blood," said Dr Tan. 'If there is a hole, we will be able to see blood flowing through a gap in the wall within the heart."
While small holes may close spontaneously - about 90 per cent of muscular ventricular holes close within a year - large holes often require intervention.
Cardiac catheterisation can be performed to close the hole. This is where a narrow, flexible tube called a catheter is inserted through a blood vessel into the heart chamber, carrying tiny devices at its tip to help patch up the hole.
Open-heart surgery is another option.
Though the outlook may appear gloomy, having a hole in the heart is not that devastating. Many patients may need only to go for regular check-ups to ensure that their condition is under control, said Dr Tan.
If the condition is not serious, patients may wait until they are older before the need for surgery is considered.
'Most children with small holes are allowed to take part in physical education classes," he said.
'They can take part in sports if they don't show any negative symptoms." However, it is best to seek the doctor's advice before participating, Dr Tan added.
Congenital heart defects occur in 8 out of 1,000 babies born in Singapore