The Burden of Congenital Heart Disease in Libya

Abstract

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. It is the most common congenital problem that accounts for up to 25% of all congenital malformations presenting in the neonatal period [1]. The cause of CHD is multifactorial. Early diagnosis and proper and early medical or surgical intervention for most of the CHD could provide anatomical correction and a normal life expectancy. Patients born with severe forms of CHD are at approximately 12 times higher risk of mortality in the first year of life, particularly if they are missed in the neonatal period. Mortality in the first year of life was 18% for all CHD that are diagnosed in infancy [2]. Cardiac surgery with poor setup could have a higher mortality than not performing surgery. Hoffman et al reported that, given the causes of variation, there is no evidence for differences in incidence between different countries or times. The general worldwide incidence of CHD is 12–15/1000 live births [3]. Due to lack of reported national epidemiological studies in Libya, it is wise to make some statistical calculations for the incidence and prevalence of CHD. The birth rate in Libya is 27.6 live births/1000 populations [4]. The total estimated number of live births with CHD is about 2000 per year, which is added every year to the already existing pool. For the details of the different types, incidence and the mathematically calculated actual number of CHD in Libyan population, see table 1. The incidence of moderate to severe forms of CHD, which require urgent cardiac management, is about 4–5/1,000 live births [3]. In Libya there is a total number of at least 400 – 600 live births/year with moderate to severe forms of CHD, who need surgical or medical intervention in the first year of life. Table 1 Types, incidence and number of newly diagnosed CHDs per vearin Libya* Surgery is the treatment of choice for most of CHD, but cardiac catheterization and intervention are becoming a routine treatment for many of CHD such as closure of patent ductus arteriosus, atrial septal defect and ventricular septal defect and balloon dilatation of pulmonary and aortic valve stenosis. Centralization of the paediatric cardiac service improves the results of the treatment of CHD. Sweden and the United Kingdom have turned towards centralization of paediatric cardiac surgery to achieve the best results. In Sweden, the overall 30-days mortality for open-heart surgery was reduced from 9.5% before centralization (1988–1991) to 1.9% (1995–1997) after centralization [5]. In 2002 the total mortality for both closed and open heart surgery was 0.0% (personal communication).