For the first time in Singapore, doctors are able to treat Tetralogy of Fallot, a congenital heart defect, without open heart surgery.

The process known as trans-catheter aortic valve replacement (TAVR) sees a specially designed heart valve delivered into the patient via a leg vain near the groin. The procedure has been successfully carried out on two patients in Singapore since August, by a team of congenital heart specialists from the National University Heart Centre Singapore (MUHCS) and the department of paediatrics at National University Hospital (NUH).

The valve is transported into the vein via a thin, hollow tube and pushed into the heart. It is crimped into a small size, but expands with the help of a balloon once it is in the right position.

TAVR takes up to a few hours and improves heart function to delay the need for an open heart surgery.

Minimal invasion results in less psychological stress

Tetralogy of Fallot affects approximately two in 1,000 live births in Singapore. The defect affects the normal functioning of the pulmonary heart valve, which controls blood flow from the right chamber of the heart to the lungs - amongst other problems.

This defect can be detected early during pregnancy, but those born with the condition have to undergo multiple surgical operations throughout their lifetime as the valve that is replaced by a synthetic tube or blood vessel from a human cadaver in early life, is prone to becoming leaky or narrowed due to wear and tear.

As a result, patients typically have to undergo a repeat surgical operation every 10 to 12 years, said Dr Edgar Tay, senior consultant at the department of cardiology at NUHCS.

"It (repeat surgery) is almost unavoidable because this is not nature's gift of a normal vessel," said Dr Tay, who added that TAVR will reduce the risks of repeat surgery.

The psychological stress of repeat surgery is reportedly reduced as patients will avoid the uncertainty of open heart surgical operations.

A steep one-off price, but more cost effective

The first TAVR in Singapore was done in 2009, however the first in the world was performed in France in 2002. Studies have shown positive results such as the valves were leakage-free for up to five years in almost all patients who underwent the procedure.

The device costs S$30,000, a steep price, but Associate Professor Quek Swee Chye, head and senior consultant of the division of paediatric cardiology at NUH said he hopes the new treatment will prove to be cost-effective in the long run.

"If you look at the total package - with a shorter hospitalisation and costly device, it may still be cheaper than a long-term hospitalisation plus the expensive surgery and the manpower to look after the patient post-operatively," he said.

He positively added that he hopes the ministry will subsidise the cost one day.

Mr Gary Cheng who suffers from Tetralogy of Fallot was the first to try TAVR in August after his heart valve that he replaced when he was two years old, begun to deteriorate.

The 21-year-old's parents were not keen on a second open heart surgery and opted for the new procedure.

"The procedure wasn't painful and I can resume my normal activities now," said Mr Cheng, who is a trainee at a sheltered workshop at voluntary welfare organisation Movement for the Intellectually Disabled of Singapore. MIMS

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