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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 2  |  Issue : 3  |  Page : 76-79

Prevalence and spectrum of congenital heart diseases in children


1 Department of Pediatrics, GB Pant Hospital, Government Medical College, Srinagar, Jammu and Kashmir, India
2 Department of Pediatrics, SKIMS Medical College, Bemina, Srinagar, Jammu and Kashmir, India

Date of Web Publication5-Sep-2014

Correspondence Address:
Mohd Ashraf
GB Pant Hospital, Government Medical College, Srinagar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-449x.140230

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  Abstract 

Background: Congenital heart disease (CHD) is one of the major causes of mortality and morbidity in the pediatric population of both the developing and developed countries. Variability in incidence and prevalence of CHD from various countries of Indian subcontinent and rest of the world could be because of genetic, cultural, and environmental factors. Objective: To find the prevalence and pattern of CHD in a tertiary care hospital in Kashmir (J&K). Materials and Methods: A retrospective analysis of case-records data of 767,921 patients (0-18 years) over 3 years and 10 months period was conducted to ascertain the prevalence and spectrum of CHDs. Results: A total of 877 patients out of 767,921, were found having CHDs measuring a prevalence of 1.12/1000. About 777 (88.5%) were the acyanotics, and 100 (11.5%) were cyanotic heart patients. Among the acyanotic heart diseases ventricular septal defect was the most frequent lesion seen in 241 (31.2%), followed by patent ductus arteriosus in 184 (24.3%) children. Among the cyanotic heart diseases tetralogy of Fallot was the most frequent cyanotic heart disease seen in 48 (48.0%) patients. Conclusion: Prevalence of 1.12/1000 among the hospital attending patients could be an underestimation of the actual disease burden in our community, and heightened awareness among the treating physicians about the cardiac diseases could actually reduce the mortality and morbidity associated with these ailments.

Keywords: Children, congenital-heart, echocardiography, prevalence


How to cite this article:
Wanni KA, Shahzad N, Ashraf M, Ahmed K, Jan M, Rasool S. Prevalence and spectrum of congenital heart diseases in children. Heart India 2014;2:76-9

How to cite this URL:
Wanni KA, Shahzad N, Ashraf M, Ahmed K, Jan M, Rasool S. Prevalence and spectrum of congenital heart diseases in children. Heart India [serial online] 2014 [cited 2019 Sep 23];2:76-9. Available from: http://www.heartindia.net/text.asp?2014/2/3/76/140230


  Introduction Top


Congenital heart disease (CHD) is defined as a gross structural abnormality of the heart or intrathoracic great vessels that is actually or potentially of functional significance. [1] CHDs are one of the major causes of infant mortality. In ~90% of the CHD cases, there is no identifiable cause that can be attributed as multifactorial defects, and the most cases are asymptomatic and discovered during routine neonatal check ups. [2] CHD is the most common congenital problem in children accounting for nearly 25% of all congenital malformations. [3] Early recognition of such diseases is of immense importance as clinical presentation and deterioration can lead to sudden collapse. [4] Incidence and prevalence of CHD vary worldwide, may be due to differences in genetic, environmental, and cultural values. In Asia, estimated prevalence is 9.3/1000 live births with relatively more pulmonary outflow obstructions and fewer left ventricular outflow tract obstructions, while estimated total CHD birth prevalence in Europe was significantly higher than in North America (8.2/1000 live births vs. 6.9/100 live births). [5]

Cardiac defects are grossly divided into acyanotic and cyanotic heart diseases, former being more common. Ventricular septal defect (VSD) (30-35%) and tetralogy of Fallot (TOF) (5-7%) are most common among acyanotic and cyanotic CHDs respectively. [6] 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 the cardiovascular system by a qualified and experienced personal. [7] CHD has a wide spectrum of severity in infants: About 2-3 infants/1000 live births will develop symptom-related to cardiac defects during 1 st year of life. [6] Prevalence studies of congenital cardiac disease are necessary to establish baseline rates, to know the time, person and geographical trends that may help to raise the awareness of early medical and surgical intervention.


  Materials and methods Top


We retrospectively analyzed the data of the discharged patients records (CHD patients) of all the live births of the hospital and records of all in and out patients, of 0-18 years age, during the period of March 2009 to December 2012. For the diagnosis of CHD, a definition proposed by Mitchell et al. was applied, that is, any gross structural abnormality of the heart or intrathoracic great vessels that is actually or potentially of functional significance excluding the systemic great arteries and veins. [1] Any patient having the signs and symptoms like shortness of breath, difficulty in feeding, excessive sweating, bluish discoloration of lips and tongue, failure to thrive, clubbing, palpitation, feeling of impending doom, fainting, light headedness, rapid breathing, discrepancy in pulse, cyanosis, heart murmur, abnormal chest X-ray, or strong family history, recurrent chest infections, high blood pressure, swelling of abdomen and feet, chest and abdomen pain, and arrhythmias and loss of consciousness, etc. were evaluated further and those suspected of cardiac disease were subjected for chest X-ray, electrocardiogram (ECG), followed by echocardiography. Care had been taken to avoid duplication of the cases in the hospital during the study period.

Prevalence, age and sex specific frequency of all kinds of CHDs we observed were computed. The different types of CHDs considered for the present investigation are: VSD, atrial septal defect, TOF, patent ductus arteriosus (PDA), pulmonary stenosis, aortic stenosis, transposition of great arteries, dextrocardia, double outlet right ventricle, tricuspid artesia, hypoplastic left heart syndrome, single ventricle, Ebstein anomaly, and complex CHDs (various types of CHDs existing together including a rare type of CHDs). Exclusion criteria included CHDs with associated syndromes, and those having acquired type of CHDs', since the present study was to know the prevalence of isolated CHDs in Kashmir. Echocardiography was performed by senior cardiologists twice in a week, except in emergency situations. Echocardiography was done as per standards laid down by the American Society of Echocardiography, [8] using the M-mode, two-dimensional and color Doppler, pulse and continuous wave echocardiogram. The following age groups were considered: Newborns (1-30 days), infants (1-12 months), toddlers and preschool children (2-5 years), school children (6-12 years), and adolescents (>12 years). Written consent was obtained from parents and/or attendants from all enrolled patients following all ethical commitments.


  Results Top


A total of 767,921 patients (aged 0-18 years) were attended in our hospital during the 3 years and 10 months between March 2009 and December 2012. These patients were subjected to a detailed history and thorough clinical examination, investigations such as X-ray chest, ECG all leads, and subsequently echocardiography. A total of 866 patients had CHD, with males 455 (52.4%), and females 412 (47.5%). This amounts a prevalence of 1.12/1000 population, details of which are shown in [Table 1]. Maximum patients were seen among the age group of 1-12 months, that is, 407 measuring 46.9%. Most common lesion among the acyanotic heart diseases (n = 767) was isolated VSD, that is, 241 patients representing 31.9% seconded by PDA in 184 (24%). Among the cyanotic heart diseases (n = 100), TOF was seen in 48 patients (48%), seconded by the transposition of the great vessels (27%). The ages at diagnosis were also different, out of total 867 patients diagnosed as CHD; 251 (28.9%) patients were neonates, 407 (46.9) were infants between 2 and 5 years were 153 (17.6%), 6-12 years school children were 4.8% and above 12 years were 13 (1.5%).
Table 1: Spectrum of congenital heart diseases as per ages of presentation and sex

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  Discussion Top


To know about the estimated index of CHDs in various population groups, several studies were carried out in past 40 years and during this period a notable improvement in diagnosis of CHD was made by the introduction of echocardiography. Our study comprised all children up to 18 years, with CHD born in our hospital, referred from other hospitals, and those attended to our hospital for a variety of reasons. Our analysis gives a prevalence of 1.12/1000 patients which are similar to other studies. [9],[10] However, it is contradicting to the high prevalence of CHDs reported from the other states of India. [11],[12],[13] Acyanotic group formed the major chunk (88%), of the total CHD patients which is in congruent with the other studies. [14],[15] The most frequent type of CHD was VSD, and maximum number of cases of CHD was of the age group 1-12 months (46.7%), and including neonates it comprised about 76% of the total CHDs' which is in accordance with other studies from rest of India, [15] earlier study from the same region, [16] and rest of the world. [17],[18],[19] The frequency of the complex and rare types of CHDs was less when compared to the western data but similar to other Indian studies. [20],[21] This could be due to the severity of the defects which might have led to the death of the patients before accessing the medical facilities and racial and genetic factors between us and them. Current prevalence of CHDs' is lesser than the earlier study from the same region [16] that could be because better peripheral health services. Various cases of CHD would have escaped diagnosis like neonates, especially born at home, who die without medical attention and those who are asymptomatic with mild to moderate degree of CHD, or those diagnosed at peripheral/private centers, this may increase our falsely low prevalence. The diagnosis of CHD may pass unnoticed in 30% of infants during the 1 st weeks of life. [22]

The magnitude of the CHD problem is considerable and is largely unrecognized, understated, and underestimated. However, encouraging results of treatment for most of the CHD from developed countries should prompt more clinicians to take up the challenge of managing these complex problems. Congenital malformations and in particular CHDs are likely to become important contributors to infant mortality in the near future. Hence, it is important to determine the exact prevalence and case burden of CHD so that appropriate changes in health policies can be recommended. [23]

 
  References Top

1.Mitchell SC, Korones SB, Berendes HW. Congenital heart disease in 56,109 births. Incidence and natural history. Circulation 1971;43:323-32.  Back to cited text no. 1
    
2.Kuehl KS, Loffredo CA, Ferencz C. Failure to diagnose congenital heart disease in infancy. Pediatrics 1999;103:743-7.  Back to cited text no. 2
    
3.Aburawi EH. The burden of congenital heart disease in Libya. Libyan J Med 2006 8;1:120-2.  Back to cited text no. 3
    
4.Wren C, Richmond S, Donaldson L. Presentation of congenital heart disease in infancy: Implications for routine examination. Arch Dis Child Fetal Neonatal Ed 1999;80:F49-53.  Back to cited text no. 4
    
5.van der Linde D, Konings EE, Slager MA, Witsenburg M, Helbing WA, Takkenberg JJ, et al. Birth prevalence of congenital heart disease worldwide: A systematic review and meta-analysis. J Am Coll Cardiol 2011;58:2241-7.  Back to cited text no. 5
    
6.Berstein D. Epidemiology and genetic basis of congenital heart disease prevalence. In: Kleigman RM, Behrman RE, Jenson HB, Stanson BF (editors) : Nelson Textbook of Pediatrics. 18 th ed. Saunders Elsevier Philadelphia. 2007. pp 1878-81.  Back to cited text no. 6
    
7.Ferencz C, Rubin JD, McCarter RJ, Brenner JI, Neill CA, Perry LW, et al. Congenital heart disease: Prevalence at livebirth. The Baltimore-Washington Infant Study. Am J Epidemiol 1985;121:31-6.  Back to cited text no. 7
    
8.Kisslo J, Byrd BF, Greiser EA, Gresser C, Gillam LD, Ivy W, et al. Recommendations of continuous quality improvement in echocardio-graphy. J Am Echocardiogr 1995;8:1-28.  Back to cited text no. 8
    
9.Sayasathid J, Tantiwongkosri K, Somboonna N. Unrecognized congenital heart disease among Thai children. J Med Assoc Thai 2009;92:356-9.  Back to cited text no. 9
    
10.Misra M, Mittal M, Verma AM, Rai R, Chandra G, Singh DP, et al. Prevalence and pattern of congenital heart disease in school children of eastern Uttar Pradesh. Indian Heart J 2009;61:58-60.  Back to cited text no. 10
    
11.Sawant SP, Amin AS, Bhat M. Prevalence, pattern and outcome of congenital heart disease in Bhabha Atomic Research Centre Hospital, Mumbai. Indian J Pediatr 2013;80:286-91.  Back to cited text no. 11
    
12.Bhat NK, Dhar M, Kumar R, Patel A, Rawat A, Kalra BP. Prevalence and pattern of congenital heart disease in Uttarakhand, India. Indian J Pediatr 2013;80:281-5.  Back to cited text no. 12
    
13.Kapoor R, Gupta S. Prevalence of congenital heart disease, Kanpur, India. Indian Pediatr 2008;45:309-11.  Back to cited text no. 13
    
14.Smitha R, Karat S C, Narayanappa D, Krishnamurthy B, Prasanth S N, Ramachandra N B. Prevalence of congenital heart diseases in Mysore. Indian J Hum Genet 2006;12:11-6.  Back to cited text no. 14
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15.Saxena A. Congenital heart diseases in India: A status report. Symposium on Pediatric Cardiology II. Indian J Pediatr 2005; 72:595-98.  Back to cited text no. 15
    
16.Ashraf M, Chowdhary J, Khajuria K, Reyaz AM. Spectrum of congenital heart diseases in Kashmir, India. Indian Pediatr 2009;46:1107-8.  Back to cited text no. 16
    
17.Samánek M, Vorísková M. Congenital heart disease among 815,569 children born between 1980 and 1990 and their 15-year survival: A prospective Bohemia survival study. Pediatr Cardiol 1999;20:411-7.  Back to cited text no. 17
    
18.Jennifer HK, Anne MA, Jack R. Effect of prenatal diagnosis on outcome in patients with congenital heart disease. Neoreviews 2005;6:326-31.  Back to cited text no. 18
    
19.Moller JH, Moodie DS, Blees M, Norton JB, Nouri S. Symptomatic heart disease in infants: Comparison of three studies performed during 1969-1987. Pediatr Cardiol 1995;16:216-22.  Back to cited text no. 19
    
20.Pai BV, Varkey CC. Spectrum of congenital heart disease in a general hospital (study of 200 cases). Indian J Pediatr 1974;41:317-21.  Back to cited text no. 20
    
21.Suresh V, Rao AS, Yavagal ST. Frequency of various congenital heart diseases: Analysis of 3790 consecutively catheterised patients. Indian Heart J 1995;47:125-8.  Back to cited text no. 21
    
22.Abu-Harb M, Hey E, Wren C. Death in infancy from unrecognised congenital heart disease. Arch Dis Child 1994;71:3-7.  Back to cited text no. 22
    
23.Vaidyanathan B, Kumar RK. The global burden of congenital heart disease. Congenit Cardiol Today 2005;3:1-8.  Back to cited text no. 23
    



 
 
    Tables

  [Table 1]


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