Acyanotic Congenital Heart Defects Research Articles

The Current Strategy in Managing Congenital and Structural Heart Disease: Find and Treat Them Appropriately

Significant progress has been made in diagnosing and treating congenital heart defects (CHDs) over the past five decades. Notable advancements include pulse oximetry screening for critical CHDs in newborns and percutaneous, catheter-based procedures, improving outcomes even in developing nations. Recent studies demonstrate favorable outcomes with device closure of acyanotic CHDs, with non-fluoroscopy techniques adopted to minimize radiation risks. Positive results are observed with right ventricular outflow tract (RVOT) stent palliation for late-presenting cyanotic congenital heart diseases such as tetralogy of Fallot (TOF). Novel interventions like reverse Potts shunt anastomosis show promise in managing pediatric pulmonary arterial hypertension (PAH), while prophylactic treatments effectively reduce postoperative arrhythmias. Fontan procedure significantly enhances survival rates for individuals with single functional ventricles, although challenges arise with aging populations. In developed countries, fetal cardiac interventions utilizing advanced imaging techniques allow for early detection and preventive interventions, reducing secondary complications. Keyword: Fetal Intervention, Fontan, Non-Fluoroscopy, Percutaneous, Reverse Potts, Rheumatic Heart Disease, RVOT Stenting.

Role of Vascular Endothelial Growth Factor as a Potential Biomarker in Congenital Heart Defects: A Systematic Review.

Several studies have investigated the role of vascular endothelial growth factor (VEGF) variants, serum levels, and correlations with other extrinsic factors in congenital heart defects (CHDs); however, the findings need confirmation. The present systematic review evaluates the association between CHDs and genetic polymorphisms and serum expressions. Relevant literature was searched through electronic databases using keywords and MeSH terms. VEGF activity was comparatively assessed between cyanotic and acyanotic CHDs, and the association between different polymorphisms and heart defects was evaluated. We ultimately evaluated 12 studies regarding the association between VEGF serum patterns and found that serum VEGF levels were upregulated or downregulated in correlation with hypoxia and hemoglobin levels and were significantly associated with cyanotic CHDs compared with acyanotic CHDs. Our results also showed a significant role for different single-nucleotide polymorphisms, including rs699947, rs2010963, and rs3025039. The findings of the current study suggested a significant association between CHDs and VEGF genetic polymorphisms or varied serum levels. Nevertheless, more comprehensive studies may provide conclusive results and valuable insights into the pathogenesis of CHDs and relevant treatment strategies.

Pattern of congenital heart defects among children in Jazan Region, Saudi Arabia: A five-year hospital-based study

ABSTRACT Background: Congenital heart defects (CHDs) are the leading cause of death and morbidity in children under one year around the world. This study explores the prevalence, patterns, and interventions of congenital heart defects in children in the Jazan region, Saudi Arabia. Methods: This was a descriptive cross-sectional study, conducted in the Jazan region, Saudi Arabia. We looked back at all of the CHD patients who went to the two tertiary hospitals in the Jazan region between January 2017 and December 2021 and collected and analyzed their background information and diagnosis. Results: During the study period, 1,275 CHD patients aged under 15 years old were identified. A total of 717 (56.24%) were males, while 558 (43.76%) were females. Acyanotic CHDs were the most common, accounting for 79.21% of all cases, while cyanotic CHDs accounted for only 20.79%. Ventricular septal defect (VSD), atrial septal defect (ASD), and patent ductus arteriosus (PDA) were the most common acyanotic CHDs, accounting for 35.69%, 24.31%, and 8% of total cases, respectively. The most common cyanotic CHDs were Tetralogy of Fallot (7.14%) and Total Anomalies of Pulmonary Venous Connection (TAPVC) (1.57%). The most common Cath intervention was patent ductus arteriosus (PDA). Conclusions: This study’s results are similar to those described in previous studies from around the world, except for the unreported Transposition of the Great Arteries (TGA) cases. This kind of information is very important for setting priorities in the Saudi Arabian health sector in light of the National Transformation Program.

Coagulation abnormalities in children with uncorrected congenital heart defects seen at a teaching hospital in a developing country.

Coagulation abnormality is a significant complication and cause of mortality in children with uncorrected congenital heart defects (CHD). The aim of this study was to determine the prevalence of coagulation abnormalities and the associated factors in children with uncorrected CHD. A cross sectional study conducted to determine the prevalence of coagulation abnormalities among 70 children with uncorrected CHD aged six months to 17 years and 70 age and sex matched apparently healthy controls. Coagulation abnormalities was determined using complete blood count, prothrombin time, activated partial thromboplastin time and D-dimer assay. The prevalence of coagulation abnormalities among children with CHD and controls was 37.1% and 7.1% respectively. Children with Cyanotic CHD had a significantly higher prevalence of coagulation abnormalities compared to children with Acyanotic CHD (57.1% versus 17.1%). Haematocrit and oxygen saturation levels were significantly associated with coagulation abnormalities. This study affirms that coagulation abnormalities are frequent in children with uncorrected CHD. Oxygen saturation and haematocrit are risk factors of coagulation abnormalities. Routine coagulation screen is recommended especially in children with cyanotic congenital heart defects to improve their quality of life and reduce morbidity and mortality while awaiting definitive surgeries.

Echocardiography: an overview - Part II

This review describes echocardiographic features of commonly encountered acyanotic congenital heart defects. Echo-Doppler features of lesions causing obstruction, namely aortic stenosis, aortic coarctation, stenosis of the pulmonary valve and pulmonary arteries were initially presented followed by discussion of lesions with left-to-right shunt namely, atrial and ventricular septal defects, patent foramen ovale, patent ductus arteriosus (PDA), and atrioventricular septal defect. A special section dedicated to evaluating hemodynamically significant PDAs in premature infants was also included. Coronary artery anomalies (both congenital and acquired) were reviewed at the conclusion of the paper.

Profile of congenital heart disease in Pediatric population: two years' experience at a teaching hospital

Background: CHDs (Congenital heart defects) are a major morbidity and mortality cause in children with a substantial worldwide health burden. Therefore, this is significant for determining their spectrum as well as identifies treatable heart defects. Aims: To study the CHD's profile in a semi urban along with rural community between age group 0 to 12 years and study different forms and frequency of occurrence of congenital heart diseases in selected cases using echocardiography as diagnostic tool. Methods: In this retrospective study, case records of 154 cases of proven cases of CHD were analyzed in detail. The relative frequency of occurrence of each acyanotic and cyanotic CHD has been noted in selected cases. The study period was between January 2015 to December 2016. Results: Of 154 cases analyzed ventricular septal defect has been found the mainly diagnosis.42 cases were detected to have ventricular septal defect followed in frequency by tetralogy of fallot which was echocardiography diagnosis in 38 cases. PDA followed by ASD were the next common acyanotic congenital heart diseases detected. In cyanotic cases, TOF was followed by transposition pathology complex. Males outnumbered females. Conclusion:We observed that CHD's profile was comparable to the published literature in our population. CHGs are widespread in our set-up, and echocardiographic early CHD detection is a safe and reliable method to diagnose CHD in children,which significantly enhances the assessment of critically sick children

Profile of congenital heart disease in Pediatric population: two years' experience at a teaching hospital

Background: CHDs (Congenital heart defects) are a major morbidity and mortality cause in children with a substantial worldwide health burden. Therefore, this is significant for determining their spectrum as well as identifies treatable heart defects. Aims: To study the CHD's profile in a semi urban along with rural community between age group 0 to 12 years and study different forms and frequency of occurrence of congenital heart diseases in selected cases using echocardiography as diagnostic tool. Methods: In this retrospective study, case records of 154 cases of proven cases of CHD were analyzed in detail. The relative frequency of occurrence of each acyanotic and cyanotic CHD has been noted in selected cases. The study period was between January 2015 to December 2016. Results: Of 154 cases analyzed ventricular septal defect has been found the mainly diagnosis.42 cases were detected to have ventricular septal defect followed in frequency by tetralogy of fallot which was echocardiography diagnosis in 38 cases. PDAfollowed by ASD were the next common acyanotic congenital heart diseases detected. In cyanotic cases, TOF was followed by transposition pathology complex. Males outnumbered females. Conclusion:We observed that CHD's profile was comparable to the published literature in our population. CHGs are widespread in our set-up, and echocardiographic early CHD detection is a safe and reliable method to diagnose CHD in children, which significantly enhances the assessment of critically sick children.

Cyanotic atrial septal defect: Literature review

Atrial septal defects (ASD) constitute a tenth of all congenital heart disease in children. It is a common cause of acyanotic congenital heart defects in children. Cyanosis in a case of ASD is something which should hint that the condition is not a simple ASD and should prompt to search for causes for the same. The conditions of cyanosis with ASD have been discussed in this article. Keywords: Atrial Septal Defect (ASD), Congenital Heart disease (CHD), Cyanosis.

Correlation between Serum Level of Matrix Metalloproteinase-2 with Left Ventricular End-diastolic Volume in Children with Heart Failure

BACKGROUND: Left ventricular end-diastolic volume (LVEDV) on echocardiography is one of the tests performed on heart failure. This refers to the volume of the left ventricle at the end of the diastolic phase, which would be increased when there is a disturbance in preload, afterload, and contractility factors. Matrix metalloproteinase-2 (MMP2) is a marker of congestive heart failure that can be examined through laboratory examinations.
 AIM: The objective of the study was to provide evidence of the association between MMP and inflammatory process as well as its correlation with LVEDV in children with heart failure.
 METHODS: This was a cross-sectional study conducted on children aged 3 months–12 years old with heart failure, who visited Sanglah Hospital, Denpasar, Indonesia from May 2017 to March 2018. Echocardiographic examination (LVEDV) and blood samples were taken to measure the serum level of MMP2 on day 1 after the subjects were diagnosed with heart failure.
 RESULTS: A total of 32 subjects with heart failure were analyzed in this study. Acyanotic congenital heart defect (CHD) was the most common cause of heart failure, as observed in 23 subjects (71.9%). Characteristics data revealed that 24 subjects (75%) were underweight, 23 (71.9%) had cardiomegaly, and 22 (68.8%) had mild heart failure. Data analysis showed a moderate positive correlation between MMP2 levels with LVEDV after controlling for the influence of age (p = 0.02; r = 0.425).
 CONCLUSION: There was a moderate positive correlation between MMP2 level and LVEDV after controlling for the age factor.

Element profiles in blood and teeth samples of children with congenital heart diseases in comparison with healthy ones

BackgroundSome elements were claimed to play a role in the pathogenesis of congenital heart defects (CHD) and influence the general well-being and health of these children. ObjectivesWe aimed to assess the levels of some elements simultaneously in the blood and teeth samples of children with cyanotic and acyanotic CHD compared with healthy children. MethodsA total of 39 children with CHD (11 with cyanotic and 28 with acyanotic CHD) and 42 age- and sex-adjusted controls were enrolled. Levels of 13 elements, including magnesium, phosphorus, calcium, chromium, manganese, iron, copper, zinc, strontium, cadmium, lead, mercury, and molybdenum, were assessed using inductively coupled plasma mass spectrometry. ResultsChildren with cyanotic and acyanotic CHD had significantly lower teeth calcium and calcium/phosphorus ratio as compared to the controls after adjusting for confounders. The mean blood iron level was found to be significantly higher in the cyanotic CHD group compared to the other groups. In addition, children with acyanotic CHD had significantly higher teeth copper levels, higher blood molybdenum and lower blood magnesium levels compared to the healthy control group. Blood cadmium and mercury levels were found to be significantly elevated in both the cyanotic and acyanotic CHD groups compared to the healthy control group. There were no differences in toxic metal levels of teeth in cases with CHD. ConclusionMonitoring adequate and balanced gestational micronutrient intake might support not only maternal health but also fetal cardiac development and infant well-being. Supplementation of magnesium should be evaluated in patients having CHD.

Pulmonary hypertension in patients with acyanotic congenital heart defects

Congenital Heart Defects (CHD) is the most common congenital disease that affects 8 out of every 1000 births. CHD can be classified as cyanotic and acyanotic. Acyanotic is the most frequently diagnosed CHD. The most common complication in acyanotic CHD is pulmonary hypertension. This descriptive study was based on medical records of acyanotic CHD patients with pulmonary hypertension in RSUD Abdul Wahab Sjahranie Samarinda from 2015 to 2016 who were diagnosed by a cardiologist and confirmed with echocardiography. There were 62 patients diagnosed with acyanotic CHD and pulmonary hypertension, which 58% of patients were diagnosed with Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD) (21%), and Patent Ductus Arteriosus (PDA) (21%). Defect sizes distribution were mostly large (66%), then medium (29%), and small (5%). There were 56% of patients diagnosed before 18 years old and 44% diagnosed after they reached 18 years old. There were 68% of female patients and 32% male patients. Pulmonary hypertension severity distribution was mild (52%), moderate (26%), and severe (22%). The most diagnosed acyanotic CHD was ASD. The defect size in acyanotic CHD was mostly large, and mostly found in female patients. The severity of pulmonary hypertension was mostly mild.

Impact of Oxidative Status in Infant and Children with Cyanotic and Acyanotic Congenital Heart Diseases

Background: There are few studies regarding the role of oxidant status (OS) in children with congenital heart defects. We believed that CHD has led to increased levels of oxidative stress and inflammation and decreased antioxidant potential. This study aimed to investigate the oxidative status and its impact on the heart in infants and children with congenital cyanotic and acyanotic heart diseases. Methods: This case control study was carried out in cardiology Unit, Pediatrics department in Zagazig University Hospital from April 2017 to October 2017. 90 infants and children were included in the study, their age ranged from 2 months and 4 years they were divided randomly into three groups. Group 1: 30 children with cyanotic congenital heart defect, group 2: 30 children with acyanotic congenital heart defect and group 3: 30 healthy children as control group. All patients were evaluated clinically and investigated for routine laboratory in addition to Oxygen saturation measurement by pulse oximeter, Serum malondialdehyde and Echocardiography using Two-dimensional and M-mode measurements were obtained. Results: There was high statistical significant difference among three studied groups regarding oxygen saturation, which was normal in control group and lower in patient group and levels of Serum malondialdehyde, was highest among cyanotic heart defect group. Conclusions: Children with congenital heart diseases are susceptible to oxidative stress especially in those with cyanotic congenital heart diseases reflected by significant decrease of Partial Pressure of Oxygen and significant increase of Serum malondialdehyde (MDA) in cyanotic group when compared with the other 2 groups.

Clinical Spectrum of congenital heart defects (CHD) detected at the child health Clinic in a Tertiary Health Facility in Ghana: a retrospective analysis

BackgroundCongenital heart defects (CHD) are the singular most common congenital anomalies and account for a significant fraction of childhood mortality and morbidity. CHD occurs in ~ 1% of livebirths globally and often requires surgical interventions to improve quality of life and survival of patients. The prevalence and clinical presentations of CHD within specific populations provide a clearer overview of the burden of CHD and informs appropriate interventions. However, there is limited data on clinical presentation and occurrence of CHD in African countries such as Ghana where most cases are either diagnosed late or missed entirely resulting in increased mortality. In this retrospective study, we assessed the clinical presentations, associated comorbidities, and prescription patterns of diagnosed CHD in a tertiary facility in Ghana.MethodThis retrospective study utilized data from electronic health records (EHR) from the child health clinic of the Cape Coast Teaching Hospital - a tertiary health facility in Ghana from January 2018 to October 2019. All suspected or provisionally diagnosed cases including those confirmed with echocardiography were included in our analysis.ResultsOver 10, 000 records were reviewed, CHD was diagnosed in 79 cases, and 51 cases had complete clinical records including the type of CHD and clinical presentation. Male to female ratio was approximately 1:1 and 77.2% of the diagnoses were in children below 5 years. Acyanotic congenital heart defects were most commonly diagnosed with ventricular septal defects (VSD) and patent ductus arteriosus (PDA) being the simplest singular CHD. Tetralogy of Fallot, was the most common complex CHD accounting for 25.5% (13) of cases. Bronchopneumonia, upper respiratory infections and pneumonia were the most commonly diagnosed comorbidities accounting for over 35% of non-cardiac sequalae based on antibiotic and diuretic use.ConclusionOur study showed that over 75% of CHD cases were diagnosed under 5 years with VSD and TOF being the most commonly diagnosed acyanotic and cyanotic lesions, respectively. This study presents preliminary data that give an overview of CHD burden in Ghana that will inform future research and appropriate interventions.

Intermediate monocytes exhibit higher levels of TLR2, TLR4 and CD64 early after congenital heart surgery

IntroductionCongenital heart surgery with cardiopulmonary bypass (CPB) initiates an immune response which frequently leads to organ dysfunction and a systemic inflammatory response. Complications associated with exacerbated immune responses may severely impact the postoperative recovery. The objective was to describe the characteristics of monocyte subpopulations and neutrophils at the level of pattern recognition receptors (PRR) and the cytokine response after CPB in infants. MethodsAn observational cohort study was conducted between June 2016 and June 2017 of infants < 2 years of age, electively admitted for surgical correction of acyanotic congenital heart defects using CPB. Fourteen blood samples were collected sequentially and processed immediately during and up to 48 h following cardiac surgery for each patient. Flow cytometry analysis comprised monocytic and granulocytic surface expression of CD14, CD16, CD64, TLR2, TLR4 and Dectin-1 (CLEC7A). Monocyte subpopulations were further defined as classical (CD14++/CD16−), intermediate (CD14++/CD16+) and nonclassical (CD14+/CD16++) monocytes. Plasma concentrations of 14 cytokines, including G-CSF, GM-CSF, IL-1β, IL-1RA, IL-4, IL-6, IL-8, IL-10, IL-12p40, IL-12p70, TNF-α, IFN-γ, MIP-1β (CCL4) and TGF-β1, were measured using multiplex immunoassay for seven points in time. ResultsSamples from 21 infants (median age 7.4 months) were analyzed by flow cytometry and from 11 infants, cytokine concentrations were measured. Classical and intermediate monocytes showed first receptor upregulation with an increase in CD64 expression four hours post CPB. CD64–expression on intermediate monocytes almost tripled 48 h post CPB (p < 0.0001). TLR4 was only increased on intermediate monocytes, occurring 12 h post CPB (p = 0.0406) along with elevated TLR2 levels (p = 0.0002).TLR4 expression on intermediate monocytes correlated with vasoactive-inotropic score (rs = 0.642, p = 0.0017), duration of ventilation (rs = 0.485, p = 0.0259), highest serum creatinine (rs = 0.547, p = 0.0102), postsurgical transfusion (total volume per kg bodyweight) (rs = 0.469, p = 0.0321) and lowest mean arterial pressure (rs = -0.530, p = 0.0135). Concentrations of IL-10, MIP-1β, IL-8, G–CSF and IL-6 increased one hour post CPB. Methylprednisolone administration in six patients had no significant influence on the studied surface receptors but led to lower IL-8 and higher IL-10 plasma concentrations. ConclusionsCongenital heart surgery with CPB induces a systemic inflammatory process including cytokine response and changes in PRR expression. Intermediate monocytes feature specific inflammatory characteristics in the 48 h after pediatric CPB and TLR4 correlates with poorer clinical course, which might provide a potential diagnostic or even therapeutic target.

Pattern of congenital heart disease among children presenting to the Uganda Heart Institute, Mulago Hospital: a 7-year review.

Congenital heart disease (CHD) is the most common congenital anomaly in children. Over half of the deaths due to CHD occur in the neonatal period. Most children with unrepaired complex heart lesions do not live to celebrate their first birthday. We describe the spectrum of congenital heart disease in Uganda. We retrospectively reviewed the data of children with CHD who presented to the Uganda Heart Institute (UHI), Mulago Hospital Complex from 2007 to 2014. A total of 4621 children were seen at the UHI during the study period. Of these, 3526 (76.3%) had CHD; 1941(55%) were females. Isolated ventricular septal defect (VSD) was the most common CHD seen in 923 (27.2%) children followed by Patent ductus arteriosus (PDA) 760 (22%) and atrial septal defects (ASD) 332 (9.4%). Tetralogy of Fallot (TOF) and Truncus arteriosus were the most common cyanotic heart defects (7% and 5% respectively). Dysmorphic features were diagnosed in 185 children, of which 61 underwent genetic testing (Down syndrome=24, 22q11.2 deletion syndrome n=10). Children with confirmed 22q11.2 deletion had conotruncal abnormalities. Isolated VSD and Tetralogy of Fallot are the most common acyanotic and cyanotic congenital heart defects. We report an unusually high occurrence of Truncus arteriosus.

Spectrum of congenital heart disease in Down syndrome at Faisalabad institute of cardiology: A retrospective study.

Congenital heart disease (CHD) is the most common structural anomaly in Down syndrome children with a variable spectrum all over the world including Pakistan. Objectives: To determine the spectrum of congenital heart disease in Down syndrome at Faisalabad Institute of cardiology (FIC) Faisalabad. Study Design: Retrospective descriptive case series. Setting: Pediatric Cardiology Department of FIC, Faisalabad. Period: From January 2013 to June 2019. Material &amp; Methods: All Consecutive patients of Down syndrome who underwent diagnostic Echocardiography at FIC were enrolled. Those having confirmed diagnosis of CHD were included in the study. Results: Out of 321Down syndrome children77.6% (n=249) had CHD and were enrolled for study. Male were 53.8% (n=134) while 46.2% were female (n=115). Majority of patients were below one year of age (57%, n=142). Acyanotic CHD was seen in 83.1 % of patients (n=207) while 16.9 % (n=42) had cyanotic CHD. Isolated cardiac defects was seen in 73.1% of patients (n=182) while 26.9 % had mixed cardiac lesions (n=67). Ventricular septal defect (VSD) was the most common (22.1%, n=55) solitary lesion followed by 14.5% cases of atrioventricular septal defect (AVSD), PDA (13.3%) and ASD (8.8%). Tetralogy of Fallot (TOF) was seen in 8.4%, AS in 1.2% while TGA, Tricuspid atresia, pulmonary valve stenosis, coarctation and Ebstein anomaly (0.8% each) were less common solitary defects. In mixed cardiac defects VSD with PDA was the most common (n=13, 5.22%) followed by VSD with ASD (n=12, 4.81%) and VSD with RVOTO (n=8, 3.21%). In AVSD cases, RVOTO was present in 2.81% (n=7), PDA with ASD was seen in 2% cases (n=5) while CcTGA, DORV, Pulmonary atresia were least common. Pulmonary Hypertension was present in 54.2% cases of left to right shunt lesions. Conclusion: Incidence of CHD in referred cases of Down syndrome is high (77.6%) at our setup. Acyanotic congenital heart defects are more common. VSD is the most common acyanotic CHD followed by AVSD while TOF is the most common cyanotic CHD.

Profile of Acyanotic Congenital Heart Defect in Children at Dr. Soetomo General Hospital Surabaya Period of January – December 2016

Introduction: Acyanotic congenital heart defect is a congenital structural abnormality arising from incomplete formation of the heart or major blood vessels which generally do not interfere with the amount of oxygen or blood that reaches the body's tissues so that cyanosis are rarely found in these patients. This research aims to evaluate the profile of acyanotic congenital heart defect patients in Paediatric Cardiology Outpatient Clinic Dr. Soetomo General Hospital Surabaya period of January – December 2016 based on 4 variables; gender, age, nutritional status, type of congenital heart disease and symptoms. Until 2017, the profile of acyanotic congenital heart defect in children in Outpatient Unit of Paediatrics Department Dr. Soetomo General Hospital Surabaya has not been much researched, so this research is expected to be used as learning reference for practitioners and other readers, and also as a reference in developing management strategies for children with acyanotic congenital heart defect in the future. Methods: This was a descriptive non-experimental study using cross-sectional design and was performed by evaluating medical record of acyanotic congenital heart defect patients in Department of Paediatrics Dr. Soetomo General Hospital Surabaya period of January – December 2016 and analysed using Microsoft Excel. Results: The results of this study revealed that majority of acyanotic congenital heart defect patients were female (53.85%) with age range between 0 – &lt;5 years old. Atrial septal defect (ASD) was the most common type of acyanotic congenital heart defect (49.8%), with sign and symptom that is commonly found in patients were failure to thrive (61.94%). Majority of patients also suffered from growth disruption with most of patients aged 0 – &lt;5 years old are severely underweight (42.46%) and most of patients aged 5 – 18 years old are having malnutrition (38.23%).

Management of Congenital Heart Disease: State of the Art; Part I-ACYANOTIC Heart Defects.

Since the description of surgery for patent ductus arteriosus in late 1930s, an innumerable number of advances have taken place in the management of congenital heart defects (CHDs). In this review the current status of treatment of seven of the most common acyanotic CHDs was reviewed. The discussion included indications for, and timing of, intervention and methods of intervention. The indications are, by and large, determined by the severity of the lesion. Pressure gradients in obstructive lesions and the magnitude of the shunt in left-to-right shunt lesions are used to assess the severity of the lesion. The timing of intervention is different for each lesion and largely dependent upon when the criteria for indications for intervention were met. Appropriate medical management is necessary in most patients. Trans-catheter methods are preferable in some defects while surgery is a better option in some other defects. The currently available medical, trans-catheter, and surgical methods to treat acyanotic CHD are feasible, safe, and effective.

Drug-related teratogenic and pathologic causes of birth defects in a tertiary hospital in Southwestern Nigeria.

Birth defects are important causes of neonatal morbidity and mortality. A good understanding of the etiology is a vital step toward developing improved treatment and preventive strategies. We conducted an audit of medical records of newborns with birth abnormalities in a tertiary hospital over a 10‐year period, using a Pro forma designed to collect information on obstetric history, antenatal history, sociodemographics of parents, and the type of birth abnormality. Of the 180 medical records reviewed, female babies were 92 (51.1%) and male babies were 86 (47.8%). The mean age of the fathers was 38.2 + 6.2, and mothers 31.8 + 4.9. Majority 115 (63.9%) of the mothers had records of acute illnesses, and 23 (12.8%) chronic illnesses during pregnancy. Unspecified febrile illness 44 (38.3%), malaria 40 (34.8%), typhoid 8 (6.9%), hypertension 13 (56.5%), pregestational diabetes 4 (17.4%), and HIV 3 (13.0%) were the commonest maternal pathologies. Most of the documented birth abnormalities were Down's syndrome 34 (15.2%); congenital hydrocephalus 32 (14.3%); acyanotic congenital heart defect 30 (13.4%); deformity of the digits 26 (11.6%); and ventricular septal defect 20 (8.9%). The prevalence of maternal pathologies calls for concern, as these may be implicated in birth defects, therefore should be further investigated in future studies.

Spectrum of congenital heart disease in neonates in a tertiary care centre of Northern India

Background: Congenital heart defects (CHDs) are an important cause of mortality and morbidity in children representing a major global health burden. Not much of Indian data is available particularly from this part of the country. So, authors conduct a retrospective study to know the spectrum of congenital heart disease in our set up.Methods: A retrospective hospital based study was carried out in the neonatal intensive care unit of SMGS Hospital, Jammu from January 2017 until December 2017 to see the spectrum of CHD.Results: There were 5552 neonates admitted during the study period out of which 68 were found to have CHD. The prevalence was 12.24 per 1000 admitted neonates. Out of 68 admitted neonates, 41were males (60.3 %) and 27 females (39.7%). Clinically Respiratory distress (51.47%) was the commonest presenting symptom followed by Cyanosis (16.18%), refusal of feed (13.23%) and murmer (10.3%).46 (67.65%) newborn had acyanotic and 22 (32.35%) cyanotic congenital heart lesions. Ventricular septal defect (27.94%) was the commonest acyanotic congenital heart defects whereas Tetrology of Fallot (14.70%) was the commonest cyanotic congenital heart diseases. Cleft lip and Cleft Palate was found in 12.5% followed by Down’s syndrome in 3.57% of cases of newborns with CHD. The mode of delivery was spontaneous in 64.71% followed by Elective LSCS were 23.53% and Emergency LSCS were 11.76%.Conclusions: There is an urgent need for government and non‑government organizations to establish well‑equipped cardiothoracic surgical centers across the country especially in Jammu to cater for children with CHDs.