Investment in a cardiac MRI machine would avoid a lot of unnecessary invasive interventions which are being carried out on patients with congenital heart disease, a British specialist believes.

Jane Somerville, the architect of the medical speciality that involves taking care of adult survivors of congenital heart disease, says that the complexity of such defects makes it even more important to have a clear picture of the situation.

"Sometimes you see things which have never been described," she said, adding that this makes it all the more important to know exactly what the defect is.

Prof. Somerville visits Malta monthly to see patients at Mater Dei Hospital's Grown-Up Congenital Heart Disease (GUCH) clinic, one of the clinics based on her model. She explained that since the island has no cardiac MRI, patients have to undergo cardiac catheterisation, during which a catheter is put into the heart arteries or inside the heart through a vein in the leg or arm.

A spokesman for the Health Ministry confirmed that there is no such equipment in Malta, saying that the service is prohibitively expensive. The spokesman said it was not enough to buy the imaging machine, and that it was also necessary to employ specialised people to run it.

However, cardiology services chairman Albert Fenech and his team were looking into the issue and into how the authorities could invest in the equipment in the coming years, the spokesman said.

Prof. Somerville said a few decades ago only some 15 per cent of patients born with congenital heart defects survived but the trend has now reversed and surgery and good care has led to an 85 to 90 per cent survival rate.

"There are quite a few survivors in Malta because the authorities had wisely sent them to the UK as children, where they have had well-developed services for some 40 years," she said.

Figures from the Malta Congenital Anomalies Registry show that 3.4 per cent of babies born between 2001 and 2003 suffered from a congenital anomaly, with heart anomalies being the most common and amounting to almost 40 per cent of all congenital anomalies. According to the newly-released European Perinatal Health Report (EPHR), 41.7 per cent of babies born with congenital anomalies in 2004 died. The figure could be high due to abortion being illegal in Malta.

Prof. Somerville pointed out that taking care of adult survivors is a very specialised area of expertise. "These are very special patients with very exotic conditions."

She stressed the importance of keeping an open mind because often doctors see things which have never been described.

Prof. Somerville said she had started her career training to be a surgeon.

"But I was no good because my hands were not connected to my head," she says with a smile. She trained as a cardiologist and became very interested in congenital heart disease, which used to take its toll in infancy. But patients were living longer and in adulthood needed special care, so Prof. Somerville created a new speciality within cardiology, taking care of grown-up survivors.

Over two years ago Prof. Somerville opened a clinic at St Luke's Hospital, which has since moved to Mater Dei and she comes to Malta every month to see patients, together with consultant cardiologist Oscar Aquilina and paediatric cardiologist Victor Grech.

"It is a demanding sub-speciality of cardiology which needs careful examination, something that is no longer very common in the western world, where doctors tend to rely too much on equipment," she said.

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