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Pattern of congenital heart disease at Lady Reading Hospital Peshawar.

Byline: Inayatullah Khan, Amir Muhammad and Taj Muhammad

ABSTRACT

Background: Congenital heart disease is a defect in the structure of heart and great vessels present at birth. Early recognition will help to treat the child and if possible get corrective surgery done. The aim of this study was to see the pattern of congenital heart disease in our set-up.

Material and Methods: This descriptive study was conducted at Department of Pediatrics, Lady Reading Hospital, Peshawar, from June 2010 to July 2011. Patient from birth to 10 years of age with clinical and echocardiographic evidence of congenital heart disease were included. Demographic profile was noted.

Results: A total of 114 patients with clinical and echocardiographic evidence of congenital heart disease were included. They were 60(52.6%) males and 54(47.4%) females with a male to female ratio of 1.1:1. Among these, 79(69.30%) had acyanotic and 35(30.7%) cyanotic congenital heart disease. Ventricular sep- tal defect (29%) followed by patent ductus arteriosus (14.9%), atrial septal defect (10.5%) and pulmonary valve stenois (7.1%) were the most common acynotic congenital heart diseases, whereas Fallot's tetrology (12.3%) followed by transposition of great vessels (7%) were the commonest cyanotic congenital heart diseases.

Conclusion: Congenital heart diseases are not uncommon in our set-up. VSD is the commonest acyanotic and Fallot's tetrology as cyanotic congental heart disease.

KEY WORDS: Congenital heart disease, Cyanotic congenital heart disease, Acyanotic congenital heart disease.

INTRODUCTION

Congenital heart disease (CHD) is one of the most common structural malformation and com- prises up to 25% of all congenital anomalies. It contributes significantly to infant morbidity and mortality.2 It occurs in 0.5-0.8% of live births,1 and each year there are about 1.5 million new cases worldwide.3

Congenital heart disease has a wide spec- trum of severity in infants: about 2-3 in 1,000 new- borns infant will be symptomatic with heart dis- ease in the first year of life.1

The prognosis for children with CHD has im- proved dramatically over a 20 years period. In 1986, 60% of deaths from CHD occurred in the first year of life, whereas in 1990s the majority of deaths occurred in adults over the age of 20.4 It is predicted that 78% of the babies with con- genital heart disease today will survive into adult- hood.5

Incidence of CHD is underestimated due to home deliveries and early discharge of mothers along with their neonates from hospitals without proper neonatal examination pertinent to cardio- vascular system by a qualified and experienced person.6 Congenital cardiac defects are grossly di- vided into two types; acynotic and cyanotic heart diseases, the former being more common. Ven- tricular septal defect and Tetrology of Fallots are the commonest among acynotic and cyanotic congenital heart disease respectively.

The aim of this study was to see the pattern of congenital heart disease in our set-up.

MATERIAL AND METHODS

This was a descriptive study carried out for a period of one year, from June 2010 to July 2011, at Pediatric Department, Lady Reading Hospital, Peshawar. Patient from birth to 10 years of age with clinical and echocardiographic evidence of congenital heart disease were included. Demo- graphic profile (name, age, sex) was noted. All the data was recorded on a proforma, and the data entered and analyzed for frequency, percent- ages and means on SPSS version 10.

Examination pertinent to cardiovascular sys- tem was done. Echocardiography 2D with Dop- pler examination was performed. Consideration was given to total number of cases of congenital heart disease, age at presentation, sex distribu- tion and type of congenital heart disease. Patients with bicuspid aortic valve in the absence of aortic

Table 1: Sex and percentage distribution of Congenital Heart Disease.

S. No###Cardiac lesion###Number###Male###Female###Percentage

1###Ventricular septal defect###33###19###14###29%

2###Patent ductus arteriosus###17###3###14###14.9%

3###Atrial septal defect###12###9###3###10.5%

4###Pulmonary valve stenosis###8###6###2###7.1%

5###Atrio-ventricular canal defect###5###1###4###4.4%

6###Coarctation of Aorta###4###1###3###3.5%

7###Tetrology of Fallot###14###10###4###12.3%

8###Transposition of the great arteries###8###5###3###7%

9###Complex congenital heart disease###7###3###4###6.1%

10###Tricuspid atresia###3###1###2###2.7%

11###Truncus arteriosus###2###1###1###1.8%

12###Total anamolous pulmonary venous return (APVR)###1###1###0###0.9%

valve stenosis, mitral valve prolapse; and cardiac malposition unaccompanied by structural heart dis- ease were excluded. Premature babies and pa- tient with acquired heart diseases were also ex- cluded.

RESULTS

A total of 114 patients were included; 60 males (52.6 %) and 54 females (47.4%), with male to female ratio of 1.1:1. Patients were from new- born to 10 years of age with mean age of 16.95+-26.81 months. More than two thirds (71%) patients were under 1 year of age. Out of these, 79 (69.3%) patients had acyanotic and 35 (30.7%) cyanotic congenital heart lesions. Ventricular sep- tal defect followed by patent ductus arteriosus, atrial septal defect, and pulmonary valve stenosis were the commonest acyanotic congenital heart defects; 29 %, 14.9%, 10.5%, 7.1% respectively. Tetrology of Fallot (12.3%) followed by transposi- tion of the great arteries (7 %) were the common- est cyanotic congenital heart diseases. (Table 1)

DISCUSSION

The objective of the present study was to determine the pattern of congenital heart disease at Lady Reading hospital Peshawar, however it does not give a true prevalence of CHD in the to- tal population. In the present study, there is slight predominance of male sex among patients with congenital heart disease, coinciding with a num- ber of reports,7-12 while in other studies, the num- ber of cases were higher among females,13-16 or no difference between sexes were observed.17-19 There was a female predominance in patent ductus arte- riosus and AV canal defects 82.35% and 80% re- spectively. This finding is consistent with that re- ported by Kenna et al20, Khaled et al21, and Aman et al22 but contrary to that observed by Masood et al.8

Most of the cases (71%) are detected in in- fancy. It is consistent with studies done by Masood et al 8and Akhtar et al 23 nationally and by Subramanyan et al24 in Oman and George and Frank- Brigs in Nigeria.25

In our study the frequency of VSD was 29%. This is comparable to worldwide incidence (25- 30%)1 and to that reported by Masood et al8 and Abbag26 but is less than what is reported by Burki and Babar19 and Shann.27 Patent ductus arteriosus is the next most common acynotic CHD (14.9%) in this study. It is consistent with that reported in Saudi Arabia26 but higher than that reported by Khaled et al21 and Rahim et al.28 Atrial septal defect ranked third in frequency (10.5%) in our study which cor- relates with Abbag.26 This observation is however contrary to Khaled et al,21 Aman et al,22 and Ahmad et al.29 Pulmonary valve stenosis is the fourth most common acyanotic congenital heart lesion (7.1%) in this study. It is also consistent with that reported by other authors. 21,22 There is a significant difference in the incidence of Coarctation of aorta in the developing countries as compared to that of developed countries.30,31 It is reported to be 3.5% in our study as compared to 10.2% in Sweden.32

Tetrology of Fallot followed by transposition of the great vessels were the commonest cyan- otic congenital heart lesions in our study. This find- ing is similar to other studies nationally23 and in- ternationally.21 Complex congenital heart disease was seen in 6% patients in this study which is com- parable with other studies.8,22,33

The cause of most congenital heart disease is unknown. Most case of are thought to be multi-factorial and result from a combina- tion of genetic predisposition and environmental stimuli.1

A growing list of CHD has been associated with specific chromosomal abnormalities, and sev- eral have been linked to specific gene defects.1

This emphasizes the importance of genetic coun- seling to patients with family history of congenital heart disease.34,35

CONCLUSION

Congenital heart diseases are not uncom- mon in our set-up. Ventricular septal defect is the commonest acyanotic and Fallot's tetrology as cyanotic congenital heart disease.

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Department of Paediatrics, Lady Reading Hospital and Khyber Teaching Hospital, Peshawar, Pakistan, Corresponding author: Dr. Inayatullah Khan Senior Registrar Children B Ward Lady Reading Hospital Peshawar, Pakistan, E-mail: kinayat9011@yahoo.com
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Author:Khan, Inayatullah; Muhammad, Amir; Muhammad, Taj
Publication:Gomal Journal of Medical Sciences
Article Type:Clinical report
Geographic Code:9PAKI
Date:Dec 31, 2011
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