Pattern of congenital heart disease at Prince Hashim Hospital-Jordan

Frequency of Congenital Cardiac Disease in Various Divisions of Khyber Pakhtunkhwa (KPK) Based on a Six-Month Analysis of Inpatients at a Tertiary Care Hospital’s Pediatric Cardiology Unit

OBJECTIVE

To identify the frequency of congenital heart disease (CHD) in various Khyber Pakhtunkhwa (KPK) divisions.

MATERIALS AND METHODS

To perform this research, we reviewed the medical records of pediatric cardiology patients hospitalized between January 2022 and July 2022. Data was taken from the cardiology department's computerized data system between January 1 and July 31, 2022. To prevent any errors in diagnosis and address them during input by the ward clerk, patients' addresses, diagnoses, and gender were verified with the computerized medical record. Data were analyzed, and frequency and percentages were calculated. Per the digital mapping of KPK districts, we stratified and examined the data among various KPK divisions.

RESULTS

Out Of the 371 patients with CHD who were admitted, 36.98% (137) were from the Peshawar division, 28.84% (107) from the Malakand division, 16.71% (62) from the Mardan division, 6.1% (23) from the Kohat division, 4.3% (16) from the Bannu division, 3.5% (13) from the Dera Ismail Khan division, and 3.5% (13) from the Hazara division. A total of 371 had CHD, of which 234 (63.07%) were cyanotic and 137 (36.92%) were cyanotic. The most prevalent acynotic congenital heart defect was patent ductus arteriosus (PDA) at 36.32% (85), followed by a ventricular septal defect (VSD) at 35.04 (82). The most frequent acyanotic congenital cardiac abnormality was tetralogy of Fallot (TOF) at 49.63% (68), which was followed by transposition of the great arteries (TGA) at 33.57% (46).

CONCLUSION

In KPK, congenital heart disease is most prevalent in the divisions of Peshawar and Malakand, while it is least prevalent in Hazara.

The Spectrum of Congenital Heart Disease in Children in the Andaman and Nicobar Islands: A Five-Year Retrospective Study

Introduction: Congenital heart disease (CHD) is an abnormality in the structure or function of the cardio-circulatory system present at birth but more often diagnosed subsequently. CHD is the most common (28%) major congenital anomaly and thus signifies a major global health problem. The primary objective is to estimate the frequency and pattern of CHD in children in the Andaman and Nicobar Islands (India).

Methods: We did a hospital-based retrospective observational study. The hospital case records of all children belonging to the age group of 0 to 12 years with newly diagnosed CHD were reviewed for the five years from January 1, 2016 to December 31, 2020. The clinical, demographic, and echocardiogram details were retrieved, and descriptive analysis was done using the Statistical Package for the Social Sciences (SPSS) for Windows Version 26 (IBM, Chicago, USA).

Results: A total of 201 (12.8 per 1000) children were newly diagnosed with CHD (out of a total of 15592 children). There were 110 (54.7%) boys and 91 (45.3%) girls in the age group of 0 to 144 months (mean ± SD: 13.86±27.13). The ventricular septal defect (VSD) is the most common congenital heart defect, accounting for 25.4% of all CHD cases. The most common cyanotic CHD was tetralogy of Fallot (TOF), comprising 8% of the total cases.

Conclusion: The spectrum of CHD in our study was largely similar to pre-existing literature. Although most of the CHDs were detected during infancy, a higher proportion of complex lesions in our study group resulted in adverse outcomes, even in surgically managed cases.

Underweight, Stunted, and Wasted among Children with Congenital Heart Disease: Acyanotic versus Cyanotic

BACKGROUND Congenital heart disease (CHD) is the most common of all congenital lesions and is the most common type of heart diseases among children. Children with congenital heart disease are at increased risk of underweight, stunted and wasted. Wasted is a reflection of acute malnutrition, stunted is a reflection of chronic malnutrition while underweight is a reflection of both. OBJECTIVE To describe the prevalence of underweight, stunted and wasted among children with acyanotic and cyanotic CHD, in tertiary center in Bali, Indonesia. METHODS An observational study with cross sectional approach was conducted in children under 5 years old with newly diagnosed CHD in Sanglah Hospital, Bali. Data were collected from medical records.  Anthropometric z-scores based on WHO 2006 reference ranges were generated for each child including weight-for-age, height-for-age and weight-for-height z-scores. Diagnosis of CHD was retrieved based on echocardiography examination. The significance of the anthropometric status differences between acyanotic and cyanotic group were assessed using Pearson’s Chi Square. RESULTS From January 2017-December 2020, we found total 200 cases of CHD which 160 (80%) cases were acyanotic CHD with predominantly ventricle septal defect (38%) and 40 (20%) cases were cyanotic CHD with predominantly Tetralogy of Fallot with all variant (40%). The prevalence of underweight, stunted and wasted in acyanotic vs cyanotic CHD were: underweight (57.5% vs 40.0%, p=0.047), stunted (47.5% vs 65%, p=0.048) and wasted (67.5% vs 50%, p=0.039). CONCLUSION The prevalence of underweight, stunted and wasted among children with acyanotic and cyanotic CHD were high. Proportion of underweight and wasted were significantly higher in acyanotic CHD, while stunted was significantly higher in cyanotic CHD.

Clinical profile and pattern of congenital heart disease in infants of diabetic mother and infants of non-diabetic mother at a tertiary care hospital

OBJECTIVES

To assess the clinical manifestations and pattern of congenital heart diseases (CHD) in infants of diabetic mothers (IDMs) and infants of non-diabetic mothers.

METHODS

A prospective cross sectional study was carried out at tertiary care center over a period of thirty months. All neonates were included in this study if CHD were identified by echocardiography within this study period. Chi-square test and Fisher's exact test were used to compare between groups.

RESULT

Out of 62 neonates, IDMs and non-IDMs were equal in number, male and female ratio was 3 : 2, and majority were delivered by cesarean section (85.5%). Mean gestational age was 35 weeks, 62.3% were preterm, and 37.7% were term. Common clinical presentations were cardiac murmur (61%), and respiratory distress (43.5%). Less common presentations were low SaO2 (27.4%), tachycardia (24.2%), and cyanosis (24.2%). Common combination of presentations were murmur and tachypnea (38.7%); cyanosis and low SaO2 (24.19%); and low SaO2 and tachypnea 15(24.19). The common echocardiographic findings were atrial septal defect (ASD; 72.6%), patent ductus arteriosus (PDA; 45.2%), and ventricular septal defect (VSD; 25.8%). ASD (77.4% vs 67.7%) and VSD (35.5% vs 16.1%) were more in IDMs, and PDA (48.4% vs 41.9%) was more in non-IDMs. These differences were not significant between groups.

CONCLUSION

Clinical presentation and echocardiographic findings of CHD were similar in IDMs and non-IDMs.

Genetics of Congenital Heart Defects: The NKX2-5 Gene, a Key Player

Congenital heart defects (CHDs) represent the biggest fraction of morbid congenital anomalies worldwide. Owing to their complex inheritance patterns and multifactorial etiologies, these defects are difficult to identify before complete manifestation. Research over the past two decades has established firmly the role of genetics in the development of these congenital defects. While syndromic CHDs are more straightforward, non-syndromic CHDs are usually characterized by multiple mutations that affect intricate inter-connected developmental pathways. Knock-out and gene expression studies in mice and other genetic models have been performed to elucidate the roles of these implicated genes. Functional analysis has not been able to resolve the complete picture, as increasingly more downstream effects are continuously being assigned to CHD mutant factors. NKX2-5, a cardiac transcription factor, has received much attention for its role in cardiac dysmorphogenesis. Approximately 50 different mutations in this gene have been identified to date, and only a few have been functionally characterized. The mutant NKX2-5 factor can regulate a number of off-targets downstream to facilitate CHD development. This review summarizes the genetic etiology of congenital heart defects and emphasizes the need for NKX2-5 mutation screening.

Prevalence and pattern of congenital heart disease in Uttarakhand, India

OBJECTIVE

To find the prevalence and pattern of congenital heart disease (CHD) at a tertiary care hospital in Uttarakhand, India.

METHODS

A thorough history and clinical examination was done for all the live births and children up to 18 y of age who presented to the institute over a period of 3 y from July 2008 through June 2011. Those suspected of having a CHD, were further evaluated with ECG, chest radiography and the diagnosis was confirmed by color Doppler echocardiography.

RESULTS

Of the 36541 children examined, 312 were identified as having congenital heart defects, thus giving a prevalence of 8.54 per 1000 children attending hospital. Only one fifth cases were diagnosed in neonatal period and the diagnosis was delayed beyond infancy in more than half of the cases. Ventricular septal defect (30.45%), atrial septal defect (17.63%), patent ductus arteriosus (9.62%), pulmonary stenosis (6.41%), tetralogy of Fallot (5.45%) and transposition of great arteries (5.13%) were the commonest defects observed. Only 9.29% of children with CHD underwent definitive treatment.

CONCLUSION

The prevalence of CHD at a tertiary referral hospital in Uttarakhand India is 8.54 per 1000 children. VSD and TOF are the most common acyanotic and cyanotic congenital heart defects respectively.