Cardiology & Cardiovascular Surgery

According to Maurizio Dondi, Head of Nuclear Medicine Section in the IAEA’s programme on Human Health “Cuba has some of the best skilled nuclear cardiologists in the region and it is thanks to their personal commitment that the IAEA activities in Cuba have been very successful with very positive outcomes”.

It has achieved a heart surgery survival rate of over 95%, including coronary and vascular operations and those linked to congenital heart defects, a figure which places the island among the most advanced countries in this field. The information was provided during the Cardiovilla 2015 International Congress, which is being held in the Euro Star Hotel in Cayo Santa María.

According to statements by Dr Eduardo Rivas, president of the Cuban Society of Cardiology, the result corresponds to the will of the Cuban government to improve the population’s quality of life, together with the efforts of the existing cardio-surgical network across the
country.
He also revealed the excellent results in pediatric heart surgery, with a high rate of effectiveness, as a result of early diagnosis of sick children, with immediate intervention before the disease develops.

There are about six hospitals with a nuclear medicine department in Havana, and a few in other provinces, for example, in Santiago de Cuba, Camaguey, Villa Clara. They work together, often treating patients from other hospitals. They also organize special scientific meeting to discuss the results of various research projects which finished during the preceding year.

International students are also to take part in the courses available at the hospital and to take part in ongoing research. Surgical procedures and outpatient procedures are performed at the hospital.
The hospital also conducts health promotion programmes, nutrition programs and
offers clinical pathology services. Overseas patients can consult the professionals at the hospital by mailing or faxing their requirements. (Reword this one)

The Children’s Heart Center was founded in 1986. This is the National Reference Center for Pediatric Cardiology and the central coordinating institution for the rest of the country.
This is where most major pediatric heart surgery is done and the national Children’s Heart Network is coordinated from here. For details of this network.

We have a National Pediatric Cardiology Network whereby every provincial capital has a chief coordinating pediatric cardiologist.
This person inter-consults with, organizes and coordinates with all of the municipal cardiologists. The major provincial pediatric hospital receives children from different parts of the province for more specialized
attention as required, and for remission to Havana if necessary. (Reword this one)

In 1986, the Cuban health system adopted the National Program for Care of Children with Cardiopathies, in order to facilitate integrated management of these cases nationally. The Program itself is subordinated to the Maternal-Child Division of the Ministry of Public

• Reduce infant mortality from cardiopathies, and improve the quality of life of children born with
  congenital heart problems.
• At the national level, offer heart surgery when indicated, to children with cardiovascular malformations.
• Prevent these pathologies where possible.
• Provide rehabilitation, especially post-operative.
• Facilitate collaboration among institutions related to this health problem.
• Develop the National Children’s Heart Network.

• In 1986, one of the first steps in the program established the Children’s Heart Center at the
  William Soler Pediatric Teaching Hospital in Havana, as the national reference center for the program. The work of the Center since then has concentrated on:
• Diagnosis and surgical treatment of congenital cardiopathies, with emphasis on the most vulnerable: newborns, infants under one year, and complex cardiopathies.
• Interventionist catheterization.
• Cardiovascular rehabilitation.
• Management of arrhythmias.
• Cardiogenetic studies.
• Teaching and research.
• Training and continuing education for specialized personnel in the National Children’s Heart Network.
• The following results have been achieved to date:
• Reduction of infant mortality due to congenital cardiopathies from 3.3 X 1,000 live births in 1980 to 0.8 X 1,000 live births in 2002-2003. Similar reductions in mortality related to cardiopathies can also be observed in other pediatric age groups. (1)
• Since 1992, the cardiovascular rehabilitation program has continued to develop, providing follow-up for over 2,000 of the patients who received surgery at the Heart Center, and reaching children throughout the provinces via the National Children’s Heart Network. (1)
• Of particular importance is the post-graduate training of specialists through programs directed by the Center, which have attracted participation from top-level specialists abroad. In 2003, Pediatric Cardiology was approved as a field of specialization by the Ministry of Public Health.
• Research has prioritized study of the incidence, prevalence and morbidity within the universe of patients identified, adopting a social medicine approach to the investigations. Genetic
  studies, prevention and rehabilitation are particularly important themes for the Center.
• The Center has collaborated with other Heart Centers in the country, which offer specialized care for children over six years of age who present less complex cardiopathies.

• Diagnosis and referral of patients, according to the gravity of their cardiopathy, prioritizing the most vulnerable groups.
• Follow-up for patients who have received surgery and those who have not, emphasizing comprehensive management (attention to cardiological care, growth and development, nutrition, immunization, etc.) and social integration (in school, later in work, during pregnancies of women patients).
• Genetic counseling to parents in the Provincial and National Genetic Counseling Centers. This is also a responsibility of the pediatric cardiologist and family physician..
• Nationwide, prenatal diagnosis is carried out via echocardiogram at 20 weeks for all pregnant
  women. When a cardiopathy is diagnosed in the fetus, a team of specialists in pediatric cardiology, obstetrics-gynecology and genetics meet with the parents to inform them about the nature of the pathology and prognosis (both with and without surgery). Parents decide to carry through or interrupt the pregnancy.
  If they decide to continue, then conditions are prepared to give specialized
  care to the newborn immediately after birth. The program for prophylaxis
  and control of rheumatic fever and rheumatic cardiopathies has noted
  positive results, considerably reducing the most serious forms of carditis and
  eliminating deaths from this cause among pediatric patients.
•  Priority has been given to early identification and follow-up of coronary risk factors for preventive cardiology in children and adolescents. Dislipidemia, high blood pressure,
  level of physical activity, obesity, diabetes and smoking are among the factors targeted by pediatric cardiologists, pediatricians and primary care physicians in the context of family and community health.
• As mentioned above, the Cardiovascular
  Rehabilitation Program for children is carried out in each province, with
  specialized personnel and equipment at pediatric hospitals and polyclinics.
• Training and post-graduate education for professionals staffing the Network
  (cardiologists, pediatricians, neonatologists, intensive care specialists, ecocardiographers, physical therapists, nurses, health technicians, social workers, etc.) is carried out through semester-long diploma courses, short courses, workshops, national and international fellowships and scientific symposia, and annual meetings of the Network itself. Such continued training
  plays a fundamental role in the activities of the Network. Local and provincial programs are also periodically assessed by national teams of specialists.
• A national computer network is now being set up to connect all the provinces to the Children’s
  Heart Center in Havana, facilitating consultation among specialists on specific cases and general scientific exchange and information.
• The social and community-based care offered at the primary level constitute the
  fundamental pillar of the National Network.