Cyanotic Congenital Heart Disease Research Articles

Extra cardiac birth defects in children with congenital heart anomalies

Background: Congenital heart disease (CHD) may be present with a syndrome containing known anomalies with specific physical findings or can be present with manifestations of a systemic defect that affects the heart and other systems. Aim of the study was to determine the prevalence and spectrum of extra-cardiac defects associated with CHD. Methods: This prospective and observational study was conducted in the age group of 1 day to 12 years with CHD chosen by purposive sampling technique. Informed consent was obtained from parents or guardians. The CHD was diagnosed on the basis of detailed clinical examination, chest X-ray and Electrocardiography and confirmed by 2D echocardiography. The extra-cardiac defects were diagnosed based on standard definitions and various investigations like CBC, LFT, KFT, USG abdomen and skull, CT, MRI, G-Band karyotype, fluorescence in situ hybridization (FISH) studies for micro-deletions, audiometry, ophthalmologic evaluation and thyroid hormone profile. Results: A total of 61,254 patients were examined during the study and 640 children were identified with CHD. So, the prevalence was 10.14 per 1000 live births. Out 640 children enrolled in the study 352 (55%) were males and 288 (45%) were females with a male female ratio of 1.2:1 and 520 (81.3%) had acyanotic CHD (ACHD) and 120 (18.3%) had cyanotic CHD (CCHD). The majority of the children with CHD belonged to the second birth order 360 (56.2%). The extra-cardiac anomalies were present in 128 (20%) cases. Out of them 77 (12%) cases had extra-cardiac anomalies associated with acyanotic CHD and 51 (8%) cases had extracardiac anomalies associated with cyanotic CHD. Out of 128 cases with extra-cardiac defects 64 (50%) cases were syndromic, 51 (39.8) cases had multiple congenital defects and 13 (10.2%) had laterality defects. Conclusions: The CHD is often associated with various extra-cardiac abnormalities.

Paucisymptomatic Tetralogy of Fallot diagnosed in a 56-year-old patient: a case report

BackgroundTetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. It is generally diagnosed and surgically repaired early in life, with good overall outcomes.Case presentationWe report the case of a patient incidentally diagnosed with paucisymptomatic TOF at the age of 56 years old, during investigations for carbon monoxide poisoning. The patient had a history of thyroidectomy, arterial hypertension, and four uncomplicated vaginal deliveries.ConclusionsThis case shows us that some patients with TOF can reach older ages without surgical correction. Late surgical repair should be meticulously decided on a case basis.

Novel rare genetic variants of familial and sporadic pulmonary atresia identified by whole-exome sequencing.

Pulmonary atresia (PA) is a severe cyanotic congenital heart disease. Although some genetic mutations have been described to be associated with PA, the knowledge of pathogenesis is insufficient. The aim of this research was to use whole-exome sequencing (WES) to determine novel rare genetic variants in PA patients. We performed WES in 33 patients (27 patient-parent trios and 6 single probands) and 300 healthy control individuals. By applying an enhanced analytical framework to incorporate de novo and case-control rare variation, we identified 176 risk genes (100 de novo variants and 87 rare variants). Protein‒protein interaction (PPI) analysis and Genotype-Tissue Expression analysis revealed that 35 putative candidate genes had PPIs with known PA genes with high expression in the human heart. Expression quantitative trait loci analysis revealed that 27 genes that were identified as novel PA genes that could be affected by the surrounding single nucleotide polymorphism were screened. Furthermore, we screened rare damaging variants with a threshold of minor allele frequency at 0.5% in the ExAC_EAS and GnomAD_exome_EAS databases, and the deleteriousness was predicted by bioinformatics tools. For the first time, 18 rare variants in 11 new candidate genes have been identified that may play a role in the pathogenesis of PA. Our research provides new insights into the pathogenesis of PA and helps to identify the critical genes for PA.

Arrhythmias And Long-Term Hemodynamic Consequences In Patient With Repaired Tetralogy Of Fallot – A Case Study

The number of patients who underwent total correction of Tetralogy of Fallot (ToF) in early life or infancy is still rising. According to CDC ToF is the most prevalent cyanotic congenital heart disease with incidences of 1 in 2500 births. Rhythm disturbances and haemodynamic disturbances including valves disorders, heart failure, residual defects and more are new challenges for clinicians taking care of adult patients with repaired ToF. Our goal was to describe such a patient and highlight further complications which may be encountered among those patients.

Neurological consequences and short–term outcome of children with diagnosis of cyanotic congenital heart diseases at a Tertiary Care Cardiac Setup of Pakistan: A single center study.

Objective: To determine the neurological consequences and short–term outcome of children with diagnosis of cyanotic congenital heart diseases (CHDs) at a tertiary care cardiac setup of Pakistan. Study Design: Single Center Observational Cohort study. Setting: Department of Pediatric Cardiology, National Institute of Cardiovascular Disease (NICVD), Karachi, Pakistan. Period: November 2021 to October 2022. Material & Methods: A total of 80 children of both genders, aged between 1 month to 12 years with known cyanotic CHD as per 2D transthoracic echocardiography were admitted in Pediatric Cardiology Department of NICVD, Karachi and were considered. At the time of enrollment, demographic characteristics along with presenting complaints were noted. Necessary baseline laboratory and radiological investigations were ordered and clinical neurological examination was done. Children were discharged and short term outcomes were labeled after 3 months follow up. Results: In a total of 80 children with cyanotic CHDs, most common underlying diagnosis was tetralogy of fallot, found in 41 (51.3%) children. The CT brain revealed ischemic infarct, brain abscess and gross oedema as the most frequent observations revealed in 47 (58.8%), 40 (50.0%) and 37 (46.3%) children. Surgical management of underlying neurological abnormality was advised in 23 (28.8%) children. After 3 months follow-up, complete recovery was observed among 43 (53.8%) children. CT findings at the time of enrollment as haemorrhagic infarct (p<0.001), brain abscess (p=0.001) and atrophic changes (p=0.032) were significantly associated with incomplete recovery. Surgery as a mode of treatment for the underlying neurological disease was associated with good recovery outcomes (p<0.001). Conclusion: Most common underlying diagnosis among children with cyanotic CHDs was tetralogy of fallot. CT findings at the time of enrollment as haemorrhagic infarct, brain abscess and atrophic changes, as well as hypotonia, down going plantars and developmental delay at the time of presentation were significantly linked with incomplete recovery.

Assessment of neurodevelopmental status using Development Assessment Scale for Indian Infants in children 6-24 months of age with congenital heart disease

ABSTRACT Context: With improved awareness, early screening and diagnosis, and better postoperative care, the survival rate and life expectancy of congenital heart disease (CHD) population is on rise, and hence there is the uttermost need to study morbidities like neurodevelopment delay, which significantly affect quality of life in long term. Aim: Assessment of Neurodevelopmental Status Using Development Assessment Scale for Indian Infants (DASII) in children 6-24 months of age with CHD. Settings and Design: This was a descriptive, cross-sectional, hospital-based study, conducted in a tertiary care hospital of Central India. Subjects and Methods: The study included children 6–24 months of age with CHD confirmed by echocardiography. Their mental development quotient (DMeQ) and motor development quotient (DMoQ) was calculated using DASII. Developmental delay is defined as DQ <70% (<2 standard deviation) in either mental or motor domain. Statistical Analysis Used: Data entered in Excel spreadsheets and analyzed using SPSS 25.0. Results: Motor delay was found in 28% children and 26% children had mental delay (P = 0.0001). Among children with cyanotic CHD, both motor and mental development was seen in 80%, while in children with acyanotic CHD 18.8% children had motor delay and 16.5% children had mental delay (P = 0.0001). The mean DMoQ and mean DMeQ was significantly lower in the cyanotic group than in acyanotic group. The mean DMoQ and mean DMeQ was found to be significantly lower in the children with severe disease as compared to children with mild disease, as well as in the high-risk group as compared to low-risk group (P = 0.0001). Conclusions: We found high rates of motor and mental delay in children with cyanotic CHD, severe cardiac lesions, and high-risk category groups. Still, there is a need to find other associated factors, which can contribute to developmental delay, identified at the time of diagnosis through appropriate screening methods. Routine follow-up of these high-risk children with neurodevelopment assessment using DASII scale and early intervention will allow maximum growth and development of pediatric population with CHD and will have a positive impact on their quality of life.

Double Jeopardy: Truncus Arteriosus with Obstructed Infracardiac Total Anomalous Pulmonary Venous Connection

Truncus arteriosus (TA) is a congenital cyanotic heart disease with admixture physiology at the great arterial level. It can have associated anomalies of the pulmonary arteries, truncal valve narrowing, etc., Total pulmonary venous anomalous drainage associated with TA is extremely rare. We report a sick young infant who presented with type I TA and obstructed infracardiac total anomalous pulmonary venous return.

Total Anomalous Pulmonary Venous Connection with Persistent Left Superior Vena Cava: A Retrospective Surgical Series

Introduction: Total anomalous pulmonary venous connection (TAPVC) is a common cyanotic congenital heart disease seen in developing countries at tertiary referral centers. Association with persistent left superior vena cava (LSVC) without innominate vein (H-connection) is an extremely rare condition which makes the surgical correction extremely challenging. Materials and Methods: This was a retrospective case record review of 18 patients with TAPVC in the presence of LSVC without innominate vein (without H-connection) at our institution from January 2007 to February 2021. We detail our experience of our modified surgical technique for this complex anatomy using various modifications for each type of TAPVC with LSVC in the absence of innominate vein. Results: Out of 18 patients of TAPVC with LSVC, 17 patients survived and are being followed up regularly. There was one mortality (5.5%) in a 5-month-old infant with double-outlet right ventricle with ventricular septal defect with severe pulmonary arterial hypertension with infracardiac TAPVC who died in intensive care unit on the 5th postoperative day. Conclusion: In our experience, the modified surgical technique for treating this complex variant of TAPVC is especially useful for favorable long-term outcomes with minimal incidence of recurrent pulmonary venous obstruction.

Epidemiological characteristics and trends in postoperative death in children with congenital heart disease (CHD): a single-center retrospective study from 2005 to 2020

ObjectivesTo analyze the epidemiological characteristics and trends in death after thoracotomy in children with congenital heart disease (CHD).MethodsThe clinical data of children with CHD aged 0–14 years who died after thoracotomy in our hospital from January 1, 2005, to December 31, 2020, were retrospectively collected to analyze the characteristics of and trends in postoperative death.ResultsA total of 502 patients (365 males; 72.7%) died from January 1, 2005, to December 31, 2020, with an average of 31 deaths per year. For these patients, the median age was 2.0 months, the median length of hospital stay was 16.0 days, the median postoperative time to death was 5.0 days, and the median risk adjustment in congenital heart surgery-1 (RACHS-1) score was 3.0. 29.5% underwent emergency surgery, 16.9% had postoperative ECMO support, and 15.9% received postoperative blood purification treatment. In the past 16 years, the deaths of children with CHD under 1 year old accounted for 80.5% of all deaths among children with CHD aged 0–14 years, and deaths (349 cases) under 6 kg accounted for 69.5% of all deaths. Age at death, weight, and disease type were characterized by annual changes.ConclusionsThe postoperative deaths of children with CHD mainly occurred in infants and toddlers who weighed less than 6.0 kg, and TGA and PA were the most lethal CHDs. The proportion of deaths has been increasing across the years among patients who are young, have a low body weight, and have complex cyanotic CHD.

COVID-19 in Cyanotic Congenital Heart Disease.

Congenital heart disease (CHD) is the most prevalent congenital defect in newborn infants. Due to the various types of heart abnormalities, CHD can have a wide range of symptoms. Cardiac lesions comprise a range of different types and accordingly varying severities. It is highly helpful to classify CHD into cyanotic and acyanotic heart diseases. In this review, we are investigating the course of Coronavirus disease 2019 (COVID-19) in cyanotic CHD patients. The infection may directly or indirectly affect the heart by affecting the respiratory system and other organs. The effect on the heart that is pressure- or volume-overloaded in the context of CHD is theoretically more severe. Patients with CHD are at a higher risk of mortality from COVID-19 infection or suffering worse complications. While the anatomic complexity of CHD does not seem to predict the severity of infection, patients with worse physiological stages are more susceptible such as cyanosis and pulmonary hypertension. Patients with CHD exhibit continuous hypoxemia and have lower oxygen saturations because of a right-to-left shunt. Such individuals run the danger of rapidly deteriorating in the event of respiratory tract infections with inadequate oxygenation. Additionally, these patients have a higher risk of paradoxical embolism. Hence, critical care should be given to cyanotic heart disease patients with COVID-19 in comparison to acyanotic patients and this is through proper management, close observation, and adequate medical therapy.

Stratifying Severity of Acute Respiratory Failure Severity in Cyanotic Congenital Heart Disease.

Hypoxemia is used to stratify severity in acute respiratory failure (ARF) but is less useful in cyanotic congenital heart disease (CCHD) due to an inability to differentiate hypoxemia from lung injury versus cardiac shunting. Therefore, we aimed to determine whether variables related to respiratory mechanics were associated with outcomes to assist in stratifying ARF severity in pediatric CCHD. We performed a retrospective cohort study from a single cardiac intensive care unit enrolling children with CCHD with ARF requiring mechanical ventilation between 2011 and 2019. Time-averaged ventilator settings and oxygenation data in the first 24h of ARF were screened for association with the primary outcome of 28-day mortality. Of 344 eligible patients, peak inspiratory pressure (PIP) and driving pressure (ΔP) were selected as candidate variables to stratify ARF severity. PIP (OR 1.10, 95% CI 1.02-1.19) and ΔP (1.11, 95% CI 1.01-1.24) were associated with higher mortality and fewer ventilator-free days (VFDs) at 28days after adjusting for age, severity of cardiac history, and FiO2. A three-level (mild, moderate, severe) severity stratification was established for both PIP (≤ 20, 21-29, ≥ 30) andΔP (≤ 16, 17-24, ≥ 25), showing increasing mortality (both P < 0.01), decreasing VFDs and increasing ventilator days in survivors (all P < 0.05) across increasing pressures. Overall, we found that higher PIP and ΔP were associated with mortality and duration of ventilation across a three-level severity stratification system in pediatric CCHD with ARF, providing a practical method to prognosticate in subjects with multifactorial etiologies for hypoxemia.

Effect of blood sampling management on reducing blood transfusions in very preterm infants.

Effect of blood sampling management on reducing blood transfusions in very preterm infants.

Outcome of Management of Tetralogy of Fallot in a Cardiac Center of a Tertiary Care Hospital in Bangladesh

Background: Congenital heart diseases (CHD) represent one of the major groups of birth defects and make up approximately 1% of human malformations. Incidence of congenital heart disease is 8-10/1000 live births. The incidence is higher in premature infants. In Bangladesh incidence of congenital heart diseases was found up to 25/1000 live birth in a one year study conducted in CMH Dhaka. Congenital cyanotic heart disease accounts for less than 25% of total congenital cardiac defects. In TOF the lungs are under-perfused as blood shunts from right to left bypassing the lungs. TOF constitutes 5-7% of congenital heart disease. It is the commonest congenital cyanotic heart disease in Bangladesh. Objective: The aim of this study was to assess outcome of management of Tetralogy of Fallot in a cardiac center of a tertiary care hospital in Bangladesh. Methodology: It was a retrospective observational study and was conducted in the department of Pediatric Cardiology of Combined Military Hospital (CMH), Dhaka, Bangladesh from January 2015 to December 2016. We included 50 patients with TOF taking treatment from our department. All the patients were divided into three groups according to treatment type. Medical management group, palliative surgery group and total intra cardiac repair group and their outcome were assessed. Results: In our study we found 6 (12%) patients were in medical management group, 8 (16%) were in palliative surgery group and 36 (72%) were in total intra cardiac repair group. Among them 33 (66%) were male and 17 (34%) were female. Majority patients 30 (60%) were in less than 3 years of age. In medical management group all the patients had oxygen saturation &lt;80%, 4 (66.68%) patients reduced frequency of hyper-cyanotic spell, 1 (16.67%) patient had cerebral abscess. In palliative surgery group 6 (75%) patients had &gt;90% oxygen saturation, 2 (25%) had &lt;90% oxygen saturation, tet spell reduced in all the cases. After total intra cardiac repair no patient had .....

WEBINAR TRAINING OF EARLY DETECTION OF CONGENITAL HEART DISEASE FOLLOWED BY ECHOCARDIOGRAPHY SCREENING IN BOJONEGORO, EAST JAVA, INDONESIA

Introduction: Congenital heart disease (CHD) affects approximately 0.8% to 1.2% with incidence rate of mortality was 81 cases per 100,000 live births. Basically, CHD is a structural abnormality of the heart and (or) great vessels that is present at birth. Limited knowledge among health workers for the etiologist, risk factors, and the high heterogeneity in CHD constitutes the major obstacles for prevention and early detection. The educational activities aim to increase the medical personnel's knowledge to conduct early detection and management of CHD in Bojonegoro. Materials and Methods: These activities consisted of training followed by echocardiography screening. The training was implemented through webinar with health workers participants in Bojonegoro. The topics contained how to detect, diagnosis and therapy, and cases simulation of CHD. Pre and Post-tests were used to evaluate knowledge level. The visitation of echocardiographic screening by Pediatric cardiologists was held a week later in Bojonegoro. Results: There were 542 participants during the webinar training. The mean score of pre-tests was 8.02/15 with only 42 participants who got the perfect score. At the end of the webinar, the mean score of post-tests was 11.38/15 with 82 participants who nally got the perfect score. Total 29 children were screened by echocardiography examination. There were 19 (65.51%) children diagnosed with acyanotic CHD, 4 (13.79%) children with cyanotic CHD, and 6 (20.7%) children were normal. Conclusion: Webinar training can improve the knowledge among health workers about early detection of CHD and there were 79.31% children diagnosed with CHD among screening participants in Bojonegoro.

Potassium Imbalance Leading to Arrhythmias in Patients Undergoing Cardiac Surgery on Cardiopulmonary Bypass

Objective: To determine the frequency of factors that cause potassium imbalance in patients with postoperative arrhythmias after cardiac Bypass surgery Material and methods: During the time period of 2 November 2018 through 10 January 2020, 100 patients with heart disease receiving open-heart surgery were enrolled in a prospective observational research conducted by the cardiac surgery department at the Punjab Institute of Cardiology in Lahore. Both genders of age 17-70 years were included and patients with cyanotic heart disease congenital heart disease, previous cardiac surgery and urgent CABG were excluded. Results: Our results showed that of 100 patients, 59 (59%) were male and 41 (41%) were female and the mean age was14.243 ± 50.12 years. 6 patients had preexisting renal failure and 9 had postoperative renal failure. Overall potassium imbalance was noted in 39 patients, 33 were hypokalemic and 6 were hyperkalemic and the mean potassium with S.D was 3.95±0.83 and 37 had postoperative arrhythmias out of which 18 (54.5%) were hypokalemic and 2 (33.3%) were hyperkalemic. Preoperative drugs, preexisting renal failure, CPB time, aortic cross clamp time, intraoperative potassium levels, time on ventilation, postoperative urine output, potassium infusion, postoperative renal failure, arrhythmias and total hospital stay were found to be statistically significant. Conclusion: Potassium imbalance post-cardiopulmonary bypass is major factor that may lead to increased risk of postoperative arrhythmias. Keywords: Potassium imbalance, cardiopulmonary bypass, postoperative arrhythmias, renal failure, hypokalemia

The matrix revolutions: How databases and database linkages will transform epidemiologic research.

The matrix revolutions: How databases and database linkages will transform epidemiologic research.

Examining the Prevalence of Iron-deficiency Anemia in Children with Cyanotic Congenital Heart Disease Admitted to the Pediatric Heart Department of Imam Reza Hospital in Mashhad between 2011 and 2019: A Cross-sectional Observational Study

Introduction: This study was performed to investigate the frequency of iron-deficiency anemia and some related factors in children with cyanotic congenital heart disease between 2011 and 2019 in Mashhad City, Iran. Method: This cross-sectional observational study was conducted with a consensus method on children under 14 years of age. The samples were diagnosed with cyanotic congenital heart disease in the pediatric heart department of Imam Reza Hospital in Mashhad and had an oxygen saturation of less than 94%. The information from the patients' files was recorded in the questionnaire. The studied children were divided into five age groups to evaluate iron-deficiency anemia. The mean and lower limit of normal erythrocyte indices were determined, and the patients with anemia were identified based on mean corpuscular hemoglobin (MCH), mean corpuscular volume (MCV), and red blood cell distribution width (RDW). The data were statistically analyzed in SPSS23 software using Chi-square and Mann-Whitney statistical tests. A significance level of 0.05 was considered. Results: Among 250 examined patients, 90 cases were included in the study (54 boys and 36 girls). Angiography was the reason for half of these patients' referral to the hospital. The highest frequency was related to patients with tetralogy of Fallot (40%). The frequency rates of iron-deficiency anemia based on MCV and MCH erythrocyte indices were 10% and 17.8%, respectively. Moreover, 64.4% of patients had increased RDW levels. Cyanosis attacks were reported positive in 85.4% of the studied population. Of note, the frequency of cyanosis attacks was not significantly different in the two gender groups (P&lt;0.494). Conclusion: Considering the high prevalence of iron-deficiency anemia, especially in children with congenital heart disease, the treatment of this disorder is necessary for all such children and should not be neglected

Evaluation of a new digital pediatric malnutrition risk screening tool for hospitalized children with congenital heart disease

BackgroundIn a cohort of hospitalized children with congenital heart disease (CHD), a new digital pediatric malnutrition screening tool as a mobile application was validated, and its effectiveness and clinical value were determined as a prospective study.Methods and resultsChildren with CHD (n = 1125) were screened for malnutrition risk. The incidence of risk and the differences among various age groups and types of CHD were characterized. The optimal threshold for the tool to determine if there is a risk of malnutrition is score 2, while the Youden index was 79.1%, and the sensitivity and specificity were 91.2% and 87.9%, respectively. Based on such criterion, 351 children were at risk of malnutrition accounting for 31.20% of the total. Compared with the non-malnutritional risk group, the median age for the group at risk for malnutrition was younger (8.641 months [4.8, 23.1] vs. 31.589 months [12.4, 54.3], P < 0.01), and the length of stay was longer (12.000 [8.0, 17.0] vs. (8.420 [5.0, 12.0], P < 0.01]. There were significant differences in malnutrition risk among different age groups (χ2 = 144.933, P < 0.01), and children under one year of age exhibited the highest risk for malnutrition and more extended hospital stay (H = 78.085, P < 0.01). The risk of malnutrition among children with cyanotic CHD was higher than in those with non-cyanotic CHD (χ2 = 104.384, P < 0.01).ConclusionsThe new digital pediatric malnutrition screening tool showed high sensitivity and specificity in children with CHD. The tool indicated that the malnutrition risk for young children and children with cyanotic or Bethesda moderate and complex CHD was higher, and the hospitalization time was longer than in the non-risk group. The tool provides a rational approach to targeted nutrition intervention and support and may improve clinical outcomes.

RETROSPECTIVE STUDY OF GLENN SHUNT WITHOUT CARDIOPULMONARY BYPASS

The bidirectional Glenn shunt improves systemic arterial oxygen saturation without increasing ventricular work or pulmonary vascular resistance (1).BDG is a commonly performed procedure for a variety of cyanotic congenital heart diseases that lead eventually to a single ventricle repair (2).It is an important intermediate palliation in patients with a structurally or functionally univentricular heart who are ultimately destined to have a Fontan-type operation (3). Avoidance of cardiopulmonary bypass (CPB) has the advantage of early extubation, less blood products, reduced requirement and duration of inotropic support (4).The end-to-side anastomosis of the superior vena cava (SVC) to the right or left pulmonary artery, which may be converted to a total cavopulmonary connection later, can effectively both increase arterial blood oxygen saturation of the patients and decrease volume overload of the ventricle (5)

Right-sided weakness in a Rwandan patient with untreated Tetralogy of Fallot

BackgroundTetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease encountered in pediatrics with surgical repair being the definitive treatment. Long-term survival after surgical repair has improved; however, reported mortality rates in untreated TOF are significant. Associated complications include neurological sequelae such as brain abscess and stroke. In countries without early intervention for congenital heart disease (including TOF), delayed presentations and complications require recognition by healthcare workers.Case presentationA 22-year-old male with a history of untreated TOF presented to Rwanda’s tertiary university hospital, University Teaching Hospital of Kigali, with acute right-sided hemiparesis. Diagnostic imaging identified a left-sided brain lesion consistent with brain abscess and cardiac mass, concerning endocardial vegetation. He was managed with intravenous antibiotics but subsequently died due to complications of septicemia.DiscussionIn countries where surgical repair of TOF is not available, early recognition and medical management are key in temporizing the development of devastating sequelae. Describing the prevalence of CHD in Rwanda is urgent, requiring further research by which effective prevention and treatment strategies can be developed.