**6. Conclusion**

There is a need to increase public awareness about congenital heart disease in developing countries so as to encourage early presentation and enhance early diagnosis. Equally important is the need to educate all categories of health workers on early detection and referral coupled with prevention measures, including incorporating such teaching into the training curricula of the various categories of health workers. The need for good quality data and the training of more specialists so as to enhance treatment of affected children cannot be over-emphasized. Even though capital intensive, the need to provide more treatment centres for affected children can also not be avoided indefinitely. These measures require that health policymakers be made aware of the extent of the problem so that more resources can be allocated for primary level care which includes prevention, early detection and referral; secondary level care including medical treatment of some complications and tertiary care which includes surgical repair and rehabilitation. All these measures need to be complemented by research into local incidence and risk factors, and support from international agencies.

#### **7. References**


over the last few decades. Some of the steps taken by those countries (Howson et al, 2008)

 Improved prenatal and peri-natal services including promotion of family planning, rubella immunization before pregnancy and folic acid fortification of commonly

Educating the public on steps to take to promote a healthy pregnancy outcome

The foregoing coupled with the realities on ground in many developing countries today, inform certain broad areas of emphasis, including the urgent need for research and accurate data, improved diagnosis and treatment and a greater emphasis on prevention than has hitherto been the case. Preventive measures in particular deserve high priority and should be integrated into primary health care. As has been suggested, achieving the millennium development goals will also help to reduce the toll of paediatric heart disease, including congenital heart disease in developing countries (Leblanc, 2009). The need for communitybased studies to generate accurate statistics on incidence, mortality and survival and the improved collection of routine data cannot be over-emphasized as such data are vital for planning intervention programmes and to justify more resource allocation. Longer term measures include the provision of more treatment facilities and the training of more specialists – obstetricians, paediatricians, cardiologists, paediatric cardiologists, cardiac surgeons, and all other allied health care professionals. This requires more resource

There is a need to increase public awareness about congenital heart disease in developing countries so as to encourage early presentation and enhance early diagnosis. Equally important is the need to educate all categories of health workers on early detection and referral coupled with prevention measures, including incorporating such teaching into the training curricula of the various categories of health workers. The need for good quality data and the training of more specialists so as to enhance treatment of affected children cannot be over-emphasized. Even though capital intensive, the need to provide more treatment centres for affected children can also not be avoided indefinitely. These measures require that health policymakers be made aware of the extent of the problem so that more resources can be allocated for primary level care which includes prevention, early detection and referral; secondary level care including medical treatment of some complications and tertiary care which includes surgical repair and rehabilitation. All these measures need to be complemented by research into local incidence and risk factors, and support from

[1] Adams, F. (1959). Congenital heart disease: comments regarding incidence and natural history. *California Medicine,* Vol. 90, No. 3, (March 1959), pp. 213-216 [2] Bannerman, C. and Mahalu, W. (1998). Congenital heart disease in Zimbabwean

children. *Annals of Tropical Paediatrics,* Vol. 18, No. 1, (March 1998), pp. 5-12, ISSN

Training of health care professionals in best practices in care and prevention

including avoidance of teratogens during gestation, etc.

allocation and more judicious use of available resources.

included:

Improved collection and use of data

consumed foods.

**6. Conclusion** 

international agencies.

0272-4936

**7. References** 


**Part 6** 

**Miscellaneous Issues** 


**Part 6** 

**Miscellaneous Issues** 

272 Congenital Heart Disease – Selected Aspects

[20] World Bank (2011). World Bank list of economies, In: *Changes in country classifications*, Accessed 23rd July 2011, Available from: http://www.data.worldbank.org [21] World Health Organization. (1996). *Control of Hereditary Diseases.* WHO Technical

[22] Yacoub, M. (2007). Establishing pediatric cardiovascular services in the developing world: a wake-up call. *Circulation,* Vol. 116, (2007) pp. 1876-1878, ISSN 0009-7322

Report Series 865. WHO, Geneva, Switzerland.

**12** 

*USA* 

**Myocardial Self-Repair** 

*Stanford University, Stanford, CA* 

**and Congenital Heart Disease** 

Fariba Chalajour, Xiaoyuan Ma and R. Kirk Riemer

In this chapter we will explore the current understanding about the dynamics of myocardial cell populations after birth and how they may contribute to homeostasis and response to injury. Recent investigations of myocardial cell biology have revealed that the heart is not the terminally differentiated organ it was once thought to be. We now know that myocardium contains limited populations of cardiac progenitor cells (CPC) that are capable of generating all myocardial cell types. The changes in myocardial cell populations with time and the role these changes play in neonatal myocardial tissue expansion will be discussed. The contribution of CPC to heart growth and therapeutic strategies for congenital

Pluripotent embryonic stem cells (ESC) are derived from the inner cell mass of an embryonic blastocyst (primitive ectoderm). The *pluri*potency of ESC defines that they are capable of differentiation into one of the three germ layers: ectoderm, mesoderm, or endoderm; reviewed in (Rossant, 2008; Bolli & Chaudhry, 2010). Embryonic mesoderm cells (identified by the expression of Brachyury T) in the developing primary heart field undergo committed differentiation into a pre-cardiac lineage (expressing Mesp-1) and have the potential to form committed cardiac progenitor cells (CPC, expressing Nkx2.5), which are capable of differentiation into cardiomyocytes, vascular smooth muscle cells, and endothelial cells; reviewed in (Sturzu & Wu, 2011). A cardiac progenitor cell is thus defined as a *multi*potent

Originally it was thought that only ESC are pluripotent, and they could only be obtained from living embryos. Consequently, studies of human ESC have been impeded by ethical concerns. However, continued research has led to the realization that pluripotency is in fact a plastic multidirectional state. It has now been clearly demonstrated that a pluripotent state can be induced in adult somatic cells from humans, and other species; reviewed in Yamanaka (Yamanaka & Blau, 2010). The biochemical methods through which so-called induced pluripotent cells (iPSC) may be derived from adult cells are numerous and still expanding. Several recent reviews (Rossant, 2008; Yamanaka & Blau, 2010) of both the technology and the biology of iPSC may be consulted for the interested reader; the topic will

**1. Introduction** 

cardiac diseases will be explored.

**2. Stem cells and heart development 2.1 Stem cells: The perspective has evolved** 

progenitor cell of the pre-cardiac lineage.

not be further discussed here.
