Management of patients with congenitally malformed hearts in Indonesia.

At a crude rate in Indonesia of 20 births per 1000 population, the total number of annual live-births is approximately 4.5 million. Considering the estimate of 9 of each 1000 affected live-births, 40,500 infants with congenitally malformed hearts are added every year to the total pool. The number of surgical procedures for such congenital cardiac malformations in the whole country in 2005 was 706. The majority of cases are undetected, contributing to a high rate of infant mortality. In the period of 3 years from 2003 through 2005, 1366 patients underwent open and closed cardiac surgical procedures at the National Cardiovascular Center in Jakarta. The rate of death was 5.56%, with a complexity score as calculated for the Aristotle system of 6.25, which is at the medium level. The proportion of surgical procedures performed in infancy has increased, but the rate of mortality for complex surgery in this particular group is still high. Non-surgical interventions have increased every year, but the cost is higher than for surgery, except for balloon pulmonary valvoplasty. Thus, by any reckoning, paediatric cardiac care in Indonesia is still in its infancy. The barriers are: lack of awareness of congenitally malformed hearts, limited resources and facilities, the high cost of treatment, and limited financial support. Training programmes exclusively dedicated to paediatric cardiology and paediatric cardiac surgery need to be established in centers with good standards of paediatric cardiac care.