SUMMARY Journal of Rawalpindi Medical College (JRMC); 2010;14(1):31-32 31 Congenital Heart Diseases in Neonates Rehan Farooqui* , Umme Farha Haroon** ,Allauddin Niazi***, Nosheen Rehan****,.Tayaba Khawar Butt , Manal Niazi . *Department of Paediatrics , Frontier Medical College , Abbottabad **Department of Neonatology, Children Hospital , Lahore *** Department of Paediatrics , Islamabad Medical and Dental College , Islamabad ****Department of Radiology, Frontier Medical College, Abbottabad Abstract Background: To determine the frequency of congenital heart diseases in neonates Methods: In this descriptive study, echocardiography was performed in all 459 suspected cases of congenital heart diseases. Results: In 162 confirmed cases, the frequency of congenital heart disease was 2.86%. Male outnumbered female (100vs 62). Acyanotic lesions were more common than cyanotic lesions (127vs 35). Ventricular Septal Defect was the most common acyanotic lesion while Transposition of Greater Arteries was the most common cyanotic lesion Conclusion: Congenital heart diseases, being one of the commonest problem in newborns, requires early diagnosis, so that the affected child can get maximum medical support and benefit Key Words: Neonates, Congenital Heart Disease (CHD), Acyanotic, Cyanotic Lesion Introduction The incidence of Congenital Heart Diseases (CHD) in different studies varies from about 4/1,000 to 50/1,000 live births.1 It accounts for nearly 25% of all congenital malformations.2 By definition CHD is a gross structural abnormality of the heart or intrathoracic great vessels that is actually or potentially of functional significance.3 Presentation can vary from asymptomatic accidental findings to severe cardiac decompensation and death. Early recognition has great implications on prognosis. Patients and Methods This descriptive study was done in Department of Neonatology Children hospital Lahore over a period of 11 months (Jan 2007-Nov2007). .All admitted neonates with the clinical suspicion of congenital heart disease, who presented with cyanosis, tachypnea or tachycardia, audible heart murmur, low oxygen saturation on pulse oximeter or X ray evidence of cardiomegaly and hemodynamically stable were included in this study. They were sent to cardiology out patient department for echocardiography. Neonates with other congenital anomalies, syndromes or hemodynamically unstable were excluded. Results Out of total 5650 admissions , 459 had clinical suspicion of CHD. Age ranged from 1 to 28 days. A total of 162 neonates were confirmed to have CHD on echocardiography. The frequency of CHD was 2.86% . Out of 162 neonates, 127 had acyanotic lesions and 35 had cyanotic lesions (Table 1).Male babies outnumbered female babies (100 versus 62).Fifty two (32.09%) cases were diagnosed within 7 days of birth, followed by 39 (24.07%) cases diagnosed within 8- 14 days after birth.(fig 1).In acyanotic lesions ventricular septal defect(VSD) was diagnosed in 58 neonates followed by patent ductus arteriosis (PDA)in 49 neonates (Table 2). In cyanotic lesions, TGA was the commonest ( 21 neonates) followed by Tetralogy of Fallot (7 neonates) ( Table 3) . Table 1: Frequency and Gender Distribution LESION NO. OF PATIENTS % M F Acyanotic 127 78.39% 77 50 Cyanotic 35 21.60% 23 12 Total 162 100% 100 62 Journal of Rawalpindi Medical College (JRMC); 2010;14(1):31-32 32 52 39 33 38 0 10 20 30 40 50 60 1-7 Days 8-14 141 Days 15-21 Days 21-28 Days No of patients Fig 1: Age Distribution Table 2: Frequency of Acyanotic Lesions: Acyanotic Lesion No of Patients % Ventricular Septal Defect (VSD) 58 45.66% Patent Ductus Arteriosus (PDA) 49 38.58% Atrial Septal Defect (ASD) 8 6.29% Combined Atrio Ventricular Septal Defect (CAVSD) 7 5.51% Pulmonary Atresia (PA) 3 2.36% Coarctation of Aorta (Co A) 2 1.57% Total 127 100% Table 3: Frequency of Cyanotic Lesions Cyanotic Lesions No. of patients % Transposition of greater arteries (TGA) 21 60.00% Tetralogy of Fallot (TOF) 7 20.00% Tricuspid Atresia 4 11.42% Pulmonary Atresia 1 2.85% Truncus Arteriosus 1 2.85% Total Anomalous Pulmonary Venous Circulation(TAPVC) 1 2.85% Total 35 100% Discussion Each year there are about 1.5 million new cases worldwide. 4 In Pakistan, approximately forty thousand child are born each year with a congenital heart disease .It is the most common congenital condition diagnosed in newborns. In Pakistan only a few centers are taking care of children , especially neonates , with congenital heart diseases. Children Hospital Lahore is a unique centre in this regard . Approximately , fifty percent surgeries in this cohort were done here at an age of less than one year. 5 In present study male outnumbered females. The result is similar as shown by Amir but Stephen et al showed equal distribution. 6,7 Acyanotic lesions are more common than cyanotic lesions.Similar inference was drawn by Jackson and Rahim.8,9 Among acyanotic lesions,VSD was the most common lesion found on echo. Similar results were shown by Rehan and Faud.10.11 PDA was found second most common lesion. Similar result were shown by Faud but differs from various studies. 11-13 It can be ascribed to the inclusion of only neonates while majority of studies included children upto 14-15 years of age. In those studies ASD was the second most common lesion. Regarding cyanotic lesions TGA was the most common lesion followed by TOF.This differs with other studies in which TOF was the most common cyanotic lesion 10 - 14. As mentioned for acyanotic lesions, in cyantoic lesions too, the difference can be because of inclusion in the study of only neonates, while majority of studies included children upto 14-15 years of age and usually Tetralogy of Fallot presents after few months of life. In conclusion, neonatology and children cardiology is a technology intense issue requirng highly trained staff . There is a dire need to establish centers and to train medical staff at all levels. Early detection of CHD is of utmost importance for its proper management. References 1. Hoffman JIE. Incidence of congenital heart disease. I. Postnatal incidence. Pediatr Cardiol. 1995;16:103–113 2. Abruawi E.The burden of Congenital Heart disease in Libya.Libyan J Med 2006;06:902. 3. Mitchell SC, Korones SB, Berendes HW. Congenital heart disease in 56,109 births. Incidence and natural history. Circulation. 1971;43:323-32. 4. Moller JH,Taubert KA,Allen HD .Cardiovascular health and disease in children: current status. A Special Writing Group from the Task Force on Children and Youth, American Heart Association. Circulation. 1994 Feb;89(2):923-30. 5. Express News . Point blank with Mubashir , 10th June , 2010. 6. Khaled A.Pattern of congenital. heart disease at Prince Hashim Hospital Jordan.Middle East Journal Of Family Medicine. 2008; (6):66 7. Stephen SS, Sigfusson, JT Syresson G. Congenital Heart defects in Iceland1990-1999 Laeknabladid 2002 Apr:88(4)281-7 8. Jackson M, Walsh KP, Peart I, Arnold R. Epidemiology of congenital heart disease in Merseyside – 1979 to 1988. Cardiol Young 1996: 6:272-280. 9. Fazal R,Mohammad Y,Amin J.Pattern of CHD in children at tertiary care centre in Peshawar.PJMS 2003; 19 (1)19-22 10. Rehan A, Zahid A, Fauzia B.A prevelance study of CHD in NWFP Pakistan .PJMS 2002;18(2)95-8 11. Faud A. Pattern Of Congenital Heart Disease in the southwestern region of Saudi Arabia. Ann Saudi Med 1998;18(5):393-395. 12. Kwon TC,KimJS,LeeSL, KimMS.Incidence of CHD in neonates by colour Doppler echo.J Korean Ped1998;41(3)363-68 Journal of Rawalpindi Medical College (JRMC); 2010;14(1):31-32 33 13. Shamima S, Azizul H, Iqbal B, Ayub A Pattern and Clinical Profile of Congenital Heart Disease in a teaching Hospital .TAJ 2008; 21(2): 58-62 14. Mumtaz H,Naseer A, Farhat M,Saqib L.Congenital Heart disease in children hospital at PIMS.J Pak Inst Med Sci 1995;6(1,2) :334-8 Rehan Farooqui* , Umme Farha Haroon** ,Allauddin Niazi***, Nosheen Rehan****,.Tayaba Khawar Butt , Manal Niazi . *Department of Paediatrics , Frontier Medical College , Abbottabad **Department of Neonatology, Children Hospital , Lahore *** Department of Paediatrics , Islamabad Medical and Dental College , Islamabad ****Department of Radiology, Frontier Medica... Abstract Introduction Patients and Methods Results Discussion References