A cross-sectional study of cardiac anomalies among children with orofacial cleft - role of echocardiography

Abstract

Background: Orofacial cleft is one of the most common congenital facial abnormalities. Congenital heart disease (CHD) has been reported in up to 15% of the patients with orofacial clefts. Clinical cardiac examinations may sometime miss cardiac anomalies in children with orofacial clefts. The aim of our study is to find out CHD by echocardiography and to correlate this with clinical examination findings in children with orofacial clefts.Methods: In this cross-sectional study, 510 patients with orofacial clefts aged 1 month to 18 years were enrolled. History and clinical examination were performed and data entered in a pre-validated proforma. The type of orofacial cleft and syndromic features was specifically noted. Echocardiography was performed for all patients by a paediatric cardiologist and the clinical cardiovascular findings were correlated with the echocardiogram.Results: The commonest deformity was cleft lip and palate (69%), followed by isolated cleft palate (20.4%), and isolated cleft lip (10.6%). In our study population, 87.5% were non-syndromic and 12.5% were syndromic; 21.9% had cardiac anomaly, of which in 7.8% no cardiac defect was detected during systemic cardiovascular examination but their echocardiogram showed cardiac abnormality. This was statistically significant (p<0.000). Atrial Septal Defect was the commonest anomaly in both the groups. Pierre Robin Syndrome was found to be the commonest syndrome.Conclusions: The high prevalence of CHD among children with orofacial clefts in this study justifies the need for screening echocardiography because many times cardiac anomalies might not be detected in routine systemic examination.