CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 3, April 2013
AFRICA
93
Cardio News
Successes, failures, challenges and ground-breaking research:
messages from the 6th World Congress of Paediatric Cardiology
and Cardiac Surgery
A remarkable cardiac event, the largest
and most prestigious yet on African
soil, took place in February this year.
The 6th World Congress of Paediatric
Cardiology and Cardiac Surgery was held
in Cape Town, with over 3 000 registered
delegates and over 2 500 scientific
attendees. It was hosted by the South
African Heart Association and organised
by the Paediatric Cardiac Society of
South Africa, a special-interest group
of the South African Heart Association,
whose major objective is to improve the
quality of care of children with congenital
and acquired heart disease.
This was reflected in the vision for
this conference: not only to host the very
best faculty and research minds but to
use the opportunity to raise awareness
of heart disease in the world’s children
and the glaring inadequacies in terms of
access to essential care. This congress,
the premier event in our speciality, would
focus equally on the needs of children and
adults with highly complex lesions and
those with acquired preventable disease
such as rheumatic heart disease, a scourge
of poverty and inequality, and ultimately
forge a new and invigorated agenda for
children with heart disease.
There were three key messages
embedded within the fabric of the
conference. Firstly, the premise is
misleading that congenital heart disease is
only the realm of paediatric cardiologists
and paediatric cardiac surgeons. Firstly,
the premise that congenital heart disease
is only the realm of paediatric cardiac
surgeons is misleading. Not only are
the numbers of adults with congenital
heart disease outstripping those born with
cardiac disease in the developed world,
with these numbers also continuing to
grow in emerging economies,
1
but it has
become clear in recent decades that in
fact the origins of non-communicable
cardiac disease lie in childhood, with
critical events occurring in the first 1 000
days of life.
2
Secondly, the most crucial
element in caring for those with heart
disease is teamwork, multisectorial and
multidisciplinary collaboration.
3
Finally,
as a congress representing the world,
the needs of the majority of the world’s
children needed to be the central tenant
throughout the congress.
With these messages in mind, several
unique elements were incorporated to
achieve these important goals. Each
day began with plenary lectures, which
allowed the delegates to congregate as a
team of healthcare providers and focus
on messages affecting practice from the
most outstanding leaders in the field.
Each day concluded with a ‘lecture of
your life’, attended by the entire audience,
which included talks on climate change,
the transcendence of injury in Olympic
and Paralympic sport and a screening of
an Oscar-nominated documentary called
‘Open Heart’. A fundamental addition to
the congress was an entire track devoted
to health systems – incorporating dialogue
from a variety of sectors, discussions
around infrastructure development,
focusing on training and lessons to
improve system inadequacies. Throughout
the day, parallel sessions were presented
with clear themes but always reflecting
the ethos of the aforementioned messages.
Rheumatic heart disease (RHD) is
thought to affect at least 36 million people
worldwide and is a predominant killer of
children, adolescents and young adults.
4
Largely eradicated in the developed
world, it continues to wreak havoc in
developing countries despite simple,
cost-effective and cheap medicines being
available for its prevention. Several key
papers were presented during the five-day
event, which reflects a renewed vigour in
this arena by countries most affected by
the disease. The announcement of a major
investment in new vaccine research by the
New Zealand and Australian government
was made by Profs Jonathan Carapetis
and Diana Lennon at a press conference
during the conference. This trans-Tasman
funding will fast-track the development
of a vaccine targeting acute rheumatic
fever (ARF) and will attempt to bring
about phase three vaccine studies within
five years.
5
Prof Bongani Mayosi refocused
attention on primary prevention of RHD
when he presented ground-breaking
research emanating from the University
of Cape Town, demonstrating the cost-
effectiveness of treating sore throat,
using penicillin, to prevent ARF.
6
The
key to managing tertiary patients with
RHD is employing a strategy of crucial
evidenced-based interventions such as
anticoagulation for those with mechanical
valves. The rheumatic heart disease global
registry (REMEDY) is a hospital-based
registry aiming to describe contemporary
patterns in the management of tertiary
patients while identifying significant
areas of concern and need.
7
Thus far, over
3 000 patients have been enrolled in this
study and already early data confirm that
even those that are being treated are not
receiving the care they need, for a variety
of reasons.
A key player in the fight against RHD
has been the World Heart Federation, with
several senior attendees. Dr Bo Remenyi
presented their strategic plan to reduce
RHD mortality by 25% in the under-25s
by 2025, an ambitious but achievable
goal.
8
It is clear that efforts such as these
highlighted at the conference are sorely
needed to effect critical changes in this
entirely preventable disease.
Advocacy messages from patients and
parents are often the most powerful. This
was highlighted in several outstanding
lectures within the plenary symposia
and the two patient and parent summits.
Ms Amy Verstappen, the president and
CEO of the Adult Congenital Heart
Association, spoke passionately about the
need to plan for a lifetime with congenital
heart disease. She stressed the fact that
congenital heart disease is a lifelong
chronic condition, and that all units with
