Prevalence of congenital heart disease among Palestinian children born in the Gaza Strip

Investigation of Genetic Causes in Patients with Congenital Heart Disease in Qatar: Findings from the Sidra Cardiac Registry

Congenital heart disease (CHD) is one of the most common forms of birth defects worldwide, with a prevalence of 1–2% in newborns. CHD is a multifactorial disease partially caused by genetic defects, including chromosomal abnormalities and single gene mutations. Here, we describe the Sidra Cardiac Registry, which includes 52 families and a total of 178 individuals, and investigate the genetic etiology of CHD in Qatar. We reviewed the results of genetic tests conducted in patients as part of their clinical evaluation, including chromosomal testing. We also performed whole exome sequencing (WES) to identify potential causative variants. Sixteen patients with CHD had chromosomal abnormalities that explained their complex CHD phenotype, including six patients with trisomy 21. Moreover, using exome analysis, we identified potential CHD variants in 24 patients, revealing 65 potential variants in 56 genes. Four variants were classified as pathogenic/likely pathogenic based on the American College of Medical Genetics and Genomics and the Association for Molecular Pathology (ACMG/AMP) classification; these variants were detected in four patients. This study sheds light on several potential genetic variants contributing to the development of CHD. Additional functional studies are needed to better understand the role of the identified variants in the pathogenesis of CHD.

Prevalence and Pattern of Congenital Heart Disease Among Children in Khartoum State, Sudan: A Reflection of the Current Cardiac Profile

Introduction

Congenital heart diseases (CHDs) are common anomalies that increase morbidity and mortality among children and adolescents. It impacts the lifestyle of survivors who live with one defect of the minor spectrum of CHD. Our research goal was directed to estimate the prevalence of CHD in Khartoum State, Sudan. Furthermore, we compared the pattern of CHD we acquired with that determined in a previous study in our country during the early nineties of the twentieth century (1994).

Methods

This is an observational cross-sectional study done by reviewing the medical records of 596 patients diagnosed with CHD from pediatric hospitals in Khartoum State between January 1, 2018, to December 31, 2019. We used a checklist with closed-ended statements; this was reviewed by pediatric cardiologists.

Results

Prevalence was determined to be 14.3/1000. There was a male predominance of 56.7%. Ventricular septal defect (VSD) was the most commonly occurring lesion (26.6%), followed by tetralogy of Fallot (TOF; 14.1%) and then patent ductus arteriosus (PDA; 10.6%). The most common combined anomalies were transposition of great arteries (TGA) and patent foramen ovale (PFO) (9.1%).

Conclusion

The prevalence of CHD in Khartoum State is estimated to be 14.3/1000, which is nearly similar to some countries in Africa but higher than most of the continent's countries. VSD was the most common isolated anomaly among CHD patients. There was slight male predominance. Our findings could be used to plan appropriate long-term strategies; to prevent a further rise in the prevalence of CHD. In addition, to be capable of investigating the predisposing factors behind CHD.

Outcome of Heart Disease in Syrian Refugee Children: Insights into Crisis

BACKGROUND

There are many challenges facing Syrian refugee children with heart disease. In this report, we present the spectrum, management, and outcome of heart disease in Syrian refugee children over six-year period, highlighting challenges in management and availability of funding.

METHODS

Data on Syrian refugee children with heart disease diagnosed between 2012 and 2017 were collected. Patients were followed until January 2019. Data reported included age, diagnosis, recommended treatment, types of procedures done, mortality, cost, financial sources for procedures, and outcome.

RESULTS

415 Syrian refugee children were diagnosed with heart disease at our institution. Median age was 1·9 years (0·4-6·05) years. Children were either born in Syria and fled to Jordan with their families (224, 54%), or born in Jordan to refugee parents (191, 46%). Follow-up was established for 335 patients (81%). Of 196 patients needing surgery, 130 (72%) underwent Surgery, and of 97 patients needing interventional catheterization, 95 underwent the procedure. Waiting time was 222(± 272) days for surgery and 67(± 75) days for catheterizations. Overall mortality was 17% (56 patients), of which 28 died while waiting for surgery. Cost of surgical and interventional catheterization procedures was $7820 (± $4790) and $2920 (± $2140), respectively. Funding was obtained mainly from non-government organizations, private donors, and United Nations fund.

CONCLUSION

Despite local and international efforts to manage Syrian refugee children with heart disease, there is significant shortage in providing treatment resulting in delays and mortality. More organized efforts are needed to help with this ongoing crisis.

Incidence and Patterns of Congenital Heart Disease Among Jordanian Infants, a Cohort Study From a University Tertiary Center

Background: Data is limited about the incidence of congenital heart disease in Jordan. The goal of this study is to determine the incidence and patterns of congenital heart diseases (CHD) among Jordanian infants evaluated at King Abdullah University Hospital. Methods: A retrospective chart review was conducted for all infants who had an echocardiogram evaluation in the 3-years period July 2016-June 2019. All included infants had a 2-dimentional echocardiogram with a Doppler vascular study performed by the same cardiologist. Infants with a structural congenital heart disease were included in the analysis. Results: A total of 1,028 infants were evaluated at the cardiology department during the study period. Eight hundred and sixty-five had an abnormal echo finding. Two hundred and ninety-eighth were diagnosed with CHD. The incidence of CHD was 25 per 1000 live births. Fifty one percent were premature infants. The majority of cases were mild CHD. Patent ductus arteriosus was the most common acyanotic lesion followed by ventricular septal defect and atrial septal defect with a prevalence of 44, 25, and 25%, respectively. Cyanotic CHD constituted 6% of all CHD. Tetralogy of Fallott was the most common cyanotic CHD. The main indication for referral was hearing a heart murmur during physical examination. Conclusion: Although the incidence of CHD in our cohort was relatively high, the majority of cases were acyanotic mild CHD with favorable prognosis. A wider population-based study is needed to evaluate the incidence and better understand the patterns and distribution of CHD at a national level.

Prenatal detection of fetal heart disease at Jordan University Hospital: early experience in a developing country

OBJECTIVE

To report on the first 5 years of establishment of fetal echocardiographic services at the Jordan University Hospital with emphasis on diagnosis and outcome.

METHODS

A retrospective chart review was conducted on all fetal echocardiographic studies performed between January 2011 and December 2015. Data collected included maternal demographics, referral indications, fetal cardiac diagnosis, correlation to post-natal diagnosis, outcome of pregnancy including pre-mature delivery and perinatal mortality. Basic statistical analysis was performed including demographic analysis, and calculation of fetal echocardiographic sensitivity and specificity.

RESULTS

A total of 208 fetuses underwent fetal echocardiographic evaluation at a mean gestational age of 26.5 (±5) weeks. The most common referral indication was a suspicion of CHD during the obstetric ultrasound (44.2%), followed by cardiac dysfunction (18.2%), and a family history of CHD (14.9%). Fetal echocardiography showed CHD in 71 fetuses (34%), heart failure in 26 (12.5%), arrhythmia in 9 (4.3%), and intracardiac masses in 2. In the remaining 100 fetuses (48%), fetal echocardiography showed normal evaluation. For detecting CHD, fetal echocardiography had a sensitivity and specificity of 91.7% and 95.4%, respectively. Perinatal mortality including termination of pregnancy, intrauterine fetal death, and neonatal mortality was highest in heart failure (77%), and was 41% for CHD.

CONCLUSION

The fetal cardiac diagnostic services at the Jordan University Hospital have encouraging initial results with a relatively high sensitivity and specificity. The services further positively impacted the quality of counselling offered and facilitated pre- and post-natal management.

Risk factors for congenital heart defects in two populations residing in the same geographic area: a long-term population-based study, Southern Israel

BACKGROUND

Congenital Heart Defects (CHD) are the most common structural defects of newborns. Southern Israel's population is comprised of Jews (75%) and Arab-Bedouins (25%). The latter has a high rate of consanguinity and low abortion rate compared with the Jewish population, which led us to suspect a higher CHD prevalence in this population. Our aim was to compare maternal risk factors that are associated with CHD in these populations.

METHODS

All births during 1991-2011 in Soroka University Medical Center (n = 247, 289) with 6078 newborns having CHD were included. To account for same-woman deliveries, general estimating equation models adjusted for ethnicity, gender and birth number were used.

RESULTS

The total prevalence of CHD was 24.6/1000 live births, with 21.4 and 30 among Jewish and Bedouin populations, respectively, (p = 0.001). Multi-variant analysis of risk factors for CHD revealed that risk factors common to both populations included conception with fertility medications, sibling CHD, maternal CHD, diabetes mellitus, hypertension and anaemia. Risk factors that were specific for the Bedouin population were - maternal age over 35 years, recurrent pregnancy loss and in vitro fertilisation. However, sibling CHD was more common as a CHD risk factor in the Jewish compared with the Bedouin population (Adjusted OR 10.23 versus 3.19, respectively).

CONCLUSIONS

The prevalence of CHD is higher in both the Bedouin and Jewish populations than previously reported. Several maternal factors were associated with CHD specifically for a certain population. Risk factors for CHD vary in populations residing in the same geographic area.

The Impact of Oral Intake of Dydrogesterone on Fetal Heart Development During Early Pregnancy

Congenital heart disease is the most frequent form of congenital anomaly in newborn infants and accounts for more than a quarter of all serious congenital afflictions worldwide. A genetic etiology is identified in <20 % of cases of congenital heart defects, and in most cases the etiology remains a mystery. In the context of the health burden caused by congenital heart disease, the contribution of non-inherited risk factors is important especially if it turns out to be caused by a drug which can be avoided during pregnancy. We sought to determine whether maternal dydrogesterone treatment in early pregnancy is associated with congenital heart disease in the infant. We conducted a retrospective case-control study of birth defects and associated risk factors. Data were obtained and compared between 202 children born with congenital heart disease and a control group consisting of 200 children. All children were born in the period of 2010-2013. Dydrogesterone exposure was defined as any reported use during the first trimester of pregnancy. Exclusion criteria included stillbirths, children with chromosomal abnormalities and infants of mothers with chronic medical illnesses, e.g., diabetes. Binary logistic regression analyses were used to analyze the data and attempt to identify a causal relationship between drug exposure and congenital heart disease. Mothers of children born with congenital heart disease received more dydrogesterone during first trimester of pregnancy than mothers of children in the control group [adjusted odds ratio 2.71; (95 % CI 1.54-4.24); P = 0.001]. We identified a positive association between dydrogesterone usage during early pregnancy and congenital heart disease in the offspring. Nevertheless, further studies are needed to confirm these results.