Prevalence Of Congenital Heart Disease Research Articles

Wound Management Across Australian and New Zealand Paediatric Cardiac Services: A Cross-Sectional Survey

The reported prevalence of congenital heart disease varies between 4 and 10 per 1,000 live births. Half of these babies will require surgical intervention in their lifetime, and almost a quarter will develop an infection related to their hospital stay, often in the sternal or thorocotomy surgical wound. Surgical site infections increase morbidity and mortality quadruple the risk of death and double the length of intensive care stay.

Prevalence of Congenital Heart Disease at Extremely High Altitudes in Tibet and the Establishment of a New Free Treatment Model

Background: This study aimed to illustrate the prevalence of CHD by screening children in extremely high-altitude areas (over 4000 m to even 5000 m above sea level) and explore an aid model for early diagnosis and treatment for the Tibetan population. Methods: A total of 2242 students from different schools in Ngamring County, Xigaze city, Tibet from September 2019 to September 2020 were selected for screening. The students were examined through the inquiry of their current medical history and family history, cardiac auscultation and a physical examination, in order to screen out the suspected cases of CHD, and then the suspected cases were confirmed by cardiac color ultrasound examinations. After that, positive patients were be transferred to Shandong Province for free treatment. Results: The prevalence of CHD among children in Ngamring County was 3.70% (83 cases), which is the highest incidence rate ever reported. The most common type of CHD was patent ductus arteriosus (PDA), accounting for 55.42% of the total number of cases screened, followed by atrial septal defect (ASD) and ventricular septal defect (VSD), accounting for 28.92% and 12.05%, respectively. The prevalence of CHD in children at high altitude was significantly higher than that in children at low altitude. The children with CHD were transferred to Shandong Province for surgery, the operations were successful and their recoveries went well. Conclusions: The results show that high altitude is closely related to the prevalence of CHD, and the incidence in Ngamring County is much higher than that in previous reports.

Persistence of Dioxin TCDD in Southern Vietnam Soil and Water Environments and Maternal Exposure Pathways with Potential Consequences on Congenital Heart Disease Prevalence in Vietnam

Waterlogged soils and submerged sediments in wetlands and agricultural lands used for rice paddies and aquaculture have anaerobic conditions that slow and prevent the photo and microbial degradation of dioxin TCDD (2,3,7,8-tetracholorodibenzo-p-dioxin), enabling it to persist in environments for long periods. Over 1.6 million ha of land in southern Vietnam were sprayed with 2,4,5-T herbicides (e.g. Agent Orange) contaminated with dioxin TCDD during the Vietnam War (1961-1971); 45% of these ha received four or more spray flight missions. Dioxins are endocrine disrupters and may induce cardiovascular disease, growth, and developmental defects, diabetes, hormonal dysfunctions and disruptions, certain cancers, and chloracne. Outpatient screening clinic 2020 data on Vietnamese children suspected of congenital heart disease (CHD) showed the childhood CHD prevalence rate in Vietnam of 13.356/1000, significantly elevated compared to the Asian CHD prevalence rate of 3.531/1000. CHD prevalence rate differences between North Vietnam (2.541/1000) and south of the 17th parallel (10.809/1000) were significant. Vietnamese farmers, especially pregnant women whose occupations involve daily contact with soil and sediments where dioxin TCDD persists in the environment may be at risk of dioxin accumulation from dermal exposure and bioaccumulation via diet. There is an urgent need for funded longitudinal genetic and clinical studies to assess CHD and other organ system childhood malformations due to in utero TCDD exposure. We recommend an integrated research design involving 1) site-specific locations that received high volumes and multiple spray loads of herbicides during the Vietnam War; 2) soil sampling of submerged and waterlogged soils and sediments where TCDD may not have degraded; 3) production areas of agriculture, fisheries, and other aquatic products; 4) risk assessment dioxin levels in foods where TCDD is likely to bioaccumulate; 5) child-bearing age and pregnant women with potentially high sensitivity to long-term low dose exposure, and 6) men and women in occupations that are in daily contact with contaminated soil and sediments as part of their job routines.

Epidemiological, Clinical, and Therapeutic Aspects of Congenital Heart Disease in Two Teaching Hospitals in Yaounde-A Cross-sectional Study

The in-hospital prevalence, type, treatment, and outcome of Congenital Heart Disease (CHD) has not been described in our setting. We carried out a cross-sectional study in two teaching hospitals in Yaounde-The Yaounde University Teaching Hospital and the Chantal Biya Foundation (Mother-Child center). We retrospectively reviewed the records of all echocardiography confirmed cases of CHD seen between 2012 and 2018. A total of 105 patients (53 males and 52 females) were included in this study. The most frequent age groups were 1 to 6 months. The in-hospital prevalence of CHD was 8.7%. A heart murmur was the most frequent index sign in 97.1% followed by pneumonia in 41% of patients. Trisomia 21 was associated with 6.7% of cases. Non-cyanotic CHD was the most frequent in (74.4%), and these were mainly ventricular septal defect (42.9%) and atrial septal defect (25.7%) of all CHD. Tetralogy of Fallot was the most frequent cyanotic CHD in 13.3% of all cases. Complications due to CHD was seen in 38.1% of cases, and this mainly pulmonary hypertension in 22 (53.7%) cases. Surgical treatment was performed in 41.9% (all abroad) with a favorable outcome in all cases. CHD represents 8.7% of in-hospital pediatric admissions, and these were mainly acyanotic. Few patients had surgical correction abroad with a good outcome in all cases.

Double Jeopardy: Prematurity and Congenital Heart Disease-What's Known and Why It's Important.

This article is based on a composite of talks presented during the Double Jeopardy: Prematurity and Congenital Heart Disease Plenary Session at NeoHeart 2020, a global virtual conference.Prematurity and low weight remain significant risk factors for mortality after neonatal cardiac surgery despite a steady increase in survival. Newer and lower weight thresholds for operability are constantly generated as surgeons gather proficiency, technical mastery, and experience in performing complex procedures on extremely small infants. The relationship between birth weight and survival after cardiac surgery is nonlinear with 2 kilograms (kg) being an inflection point below which marked decline in survival occurs.The prevalence of congenital heart disease (CHD) in premature infants is more than twice that in term born infants. Increased risk of preterm birth in infants with CHD is most commonly due to spontaneous preterm birth and remains poorly understood.Advances in Neonatal-Perinatal medicine have led to a marked improvement in survival of neonates born prematurely over the last several decades. However, the risk of severe morbidities including retinopathy of prematurity, intraventricular hemorrhage, bronchopulmonary dysplasia and necrotizing enterocolitis remains significant in extremely low birth weight infants. Premature infants with CHD are at a greater risk of prematurity related morbidities than premature infants without CHD. Interventions that have been successful in decreasing the risk of these morbidities are addressed.

Generating Evidence From Contextual Clinical Research in Low- to Middle Income Countries: A Roadmap Based on Theory of Change.

Along with inadequate access to high-quality care, competing health priorities, fragile health systems, and conflicts, there is an associated delay in evidence generation and research from LMICs. Lack of basic epidemiologic understanding of the disease burden in these regions poses a significant knowledge gap as solutions can only be developed and sustained if the scope of the problem is accurately defined. Congenital heart disease (CHD), for example, is the most common birth defect in children. The prevalence of CHD from 1990 to 2017 has progressively increased by 18.7% and more than 90% of children with CHD are born in Low and Middle-Income Countries (LMICs). If diagnosed and managed in a timely manner, as in high-income countries (HICs), most children lead a healthy life and achieve adulthood. However, children with CHD in LMICs have limited care available with subsequent impact on survival. The large disparity in global health research focus on this complex disease makes it a solid paradigm to shape the debate. Despite many challenges, an essential aspect of improving research in LMICs is the realization and ownership of the problem around paucity of local evidence by patients, health care providers, academic centers, and governments in these countries. We have created a theory of change model to address these challenges at a micro- (individual patient or physician or institutions delivering health care) and a macro- (government and health ministries) level, presenting suggested solutions for these complex problems. All stakeholders in the society, from government bodies, health ministries, and systems, to frontline healthcare workers and patients, need to be invested in addressing the local health problems and significantly increase data to define and improve the gaps in care in LMICs. Moreover, interventions can be designed for a more collaborative and effective HIC-LMIC and LMIC-LMIC partnership to increase resources, capacity building, and representation for long-term productivity.

Congenital Heart Deffcts in Hirschsprung’s disease: A survey in Iranian population

Congenital Heart Defects in Hirschsprung’s Disease: A Survey in Iranian Population Abstract Hirschsprung’s disease (HSCR) may be accompanied by other anomalies including congenital heart disease (CHD) resulting in additional complications. This study was performed to evaluate the prevalence and type of concomitant CHD in hospitalized children with Hirschsprung’s disease. Materials and Methods: All HSCR patients (129 children) admitted to Mofid children’s hospital-Tehran, from April 2016 to August 2019 were studied in a descriptive cross-sectional study. Two-dimensional, M-mode and pulsed, continuous, and color-Doppler provided echocardiography were applied to evaluate cardiac structure and function. Results: Congenital heart disease (CHD) was observed in 48 (37.2%) children. The most common anomalies were ASD in 20(15.5%), VSD in 1(0.8%), PDA in 2(1.6%), Tetralogy of Fallot (TF) in 3(2.3%), ASD and pulmonary stenosis (PS) in 2(1.6%), ASD and PDA in7 (5.4%), ASD and VSD in 3(2.3%), VSD and PDA in 2 (1.6%) of the patients. Conclusion: Cardiac anomalies are relatively prevalent in our Iranian Hirschsprung’s disease population. We recommend early echocardiographic evaluation in the setting of HSCR.

Assessment of the prevalence of congenital heart disease in children with pneumonia in tertiary care hospital: A cross-sectional study

Background and objectivesPneumonia is the most common cause of death in children under five years of age. Epidemiological factors and the disease burden differ in developing and industrialized countries. The present study is a cross sectional observational study, carried out from August 2018 to August 2020 in Hindu Rao Hospital, to assess the prevalence of congenital heart disease (CHD) in patients with pneumonia in children up to 5 years. The main objectives of the study were to study the prevalence of congestive cardiac failure (CCF) in pneumonia with and without congenital heart disease. Material and methodsPatients under 5 years of age, presenting with pneumonia during August 2018 to July 2020 were enrolled for study. The bio-data of each patient was documented each patient was clinically evaluated thoroughly and findings noted. Pneumonia was diagnosed on typical history, physical findings, blood investigations and chest radiographic finding of pneumonia infiltrates in either one or both lung fields. All the cases of pneumonia underwent transthoracic 2 Dimensional (2D) and Doppler echocardiography, done by the cardiologist. Any congenital heart disease so found was noted. The type and size of the defects was documented. The ventricular septal defects were classified based on the site and size. The size of the patient ductus arteriosus was also determined. These measurements were taken to evaluate the impact of defect size on pneumonia. CCF was diagnosed when the patient fulfilled the clinical diagnostic criteria of heart failure. All the cases of pneumonia underwent transthoracic 2 Dimensional (2D) and Doppler echocardiography for diagnosis of any congenital heart disease. ResultsMean age of the children with pneumonia was 9.94 months with 77.5% of the cases below 1 year of age. Male predominance was seen with 56.3% males to 43.8% females. Prevalence of congenital heart disease among cases of pneumonia was 12.5% while that of congestive heart failure was 27.5%. Most common CHD observed was VSD (14 cases; 8.8%) followed by PDA, ASD and TGA (4; 2.5% and 3; 1.9% and 1; 0.6% cases respectively). A significant association was observed between presence of congenital heart disease and development of CCF. ConclusionOur study demonstrates that most patients with pneumonia or recurrent pneumonia are likely to have an underlying illness at the time of pneumonia. Recurrent ALRTI often occurred in children with history of congenital heart diseases (CHD) and is also associated with Congestive Cardiac Failure. Children with CHD are more vulnerable to recurrent respiratory tract infection.

Birth prevalence of congenital heart disease among newborns in a tertiary hospital in Benin City, Nigeria.

Congenital heart disease (CHD) is an important cause of childhood morbidity. The birth prevalence and distribution of CHD among neonates in a tertiary hospital in Nigeria was determined. This descriptive, cross-sectional study involved consecutive neonates in the neonatal and postnatal wards of the hospital. Bedside echocardiography was conducted on all neonates. Data entry and analysis was done with IBM-SPSS version 20.0. A total of 2 849 neonates were recruited, consisting of 1 482 (52.0%) males. Forty-one neonates had CHD, giving a birth prevalence of 14.4/1 000 live births. Of the 41 with CHD, 21 (51.2%) were male. Thirty-six (87.8%) neonates had acyanotic CHD, of which the commonest was isolated ventricular septal defect [11 (26.8%)]. Transposition of the great arteries [3 (7.3%)] was the commonest cyanotic CHD. The birth prevalence of 14.4/1 000 live births in this study is high and buttresses the need for strengthening existing cardiac services in Nigeria.

To Determine the Frequency of Congenital Heart Disease in Infants of Diabetic Mothers

Aim: To determine the frequency of Congenital Heart Disease in infants of diabetic mother. Methodology: Cross sectional (Descriptive) study conducted in the Department of Pediatrics Special Care Baby Unit (SCBU) Khyber Teaching Hospital Peshawar from 15-04-2015 to 15-10-2015. The sample size was150 patients, using 52.5% incidence of CHD in IDM and 95% confidence interval with 8% margin of error under WHO software Results: This study was carried out on 150 patients at the Department of Pediatrics, Khyber Teaching Hospital Peshawar. CHD was detected in 79 (52.7%) patients while in 71 (47.33%) patients, CHD was not detected. Conclusion: Our study concluded moderate prevalence of Congenital Heart Disease in infants born to diabetic mothers. Keywords: Diabetes mellitus, Pregnancy, Newborn, Heart defects

Relationship of ventricular assist device support duration with pediatric heart transplant outcomes

There is wide variability in the timing of heart transplant (HTx) after pediatric VAD implant. While some centers wait months before listing for HTx, others accept donor heart offers within days of VAD surgery. We sought to determine if HTx within 30 days versus ≥ 30 after VAD impacts post-HTx outcomes. Children on VAD pre-HTx were extracted from the Pediatric Heart Transplant Study database. The primary endpoints were post-HTx length of hospital stay (LOS) and one-year survival. Confounding was addressed by propensity score weighting using inverse probability of treatment. Propensity scores were calculated based on age, blood type, primary cardiac diagnosis, decade, VAD type, and allosensitization status. A total of 1064 children underwent VAD prior to HTx between 2000 to 2018. Most underwent HTx ≥ 30 days post-VAD (70%). Infants made up 22% of both groups. Patients ≥ 12 years old were 42% of the < 30 days group and children 1 to 11 years comprised 47% of the ≥ 30 days group (p < 0.001). There was no difference in the prevalence of congenital heart disease vs. cardiomyopathy (p=0.8) or high allosensitization status (p=0.9) between groups. Post-HTx LOS was similar between groups (p=0.11). One-year survival was lower in the < 30 days group (adjusted mortality HR 1.76, 95% CI 1.11-2.78, p=0.016). A longer duration of VAD support prior to HTx is associated with a one-year survival benefit in children, although questions of patient complexity, post-VAD complications and the impact on causality remain. Additional studies using linked databases to understand these factors will be needed to fully assess the optimal timing for post-VAD HTx.

First descriptive study of congenital heart diseases in French Guiana showing complex epidemiological trends compared to mainland France

Basics French Guiana is an overseas department with diverse population composition. Despite its integration in a European model, there are social issues and high infant mortality, with unknown congenital Heart Disease (CHD) prevalence. Fetal screening, terminations of pregnancy (TOPFA), prevalence, associated chromosomal or genetics anomalies (CGA) and infant mortality of all CHD diagnosed in French Guiana are compared to published data from greater Paris (EPICARD population study, France). Five-year retrospective study including all patients with CHD born in French Guiana from January 2012 to December 2016, as well as CHD diagnosed during pregnancy over the same period. The last cases included were those in the 2016 birth cohort who were diagnosed in 2017. Over 33,796 births [32,975 live births (LB)] during the study period, a total of 231 CHD (56 fetuses), with 18.6% of CGA, were diagnosed including 215 LB (TOPFA rate: 6.5%). The total and the LB prevalence of CHD were 68.4 [95% confidence interval (CI): 67.9–68.8], and 65.2 [95% CI: 64.7–65.7] per 10,000. Having excluded CGA and isolated ventricular septal defects (VSD), the LB prevalence of CHD appeared similar in both regions, while the total prevalence (8/10,000 births, P = 0.03) and LB prevalence (3.9/10,000 LB, P < 0.002) of univentricular hearts were higher. The total infant mortality associated with CHDs in French Guiana is 9.4/10,000 LB, and represents twice the one observed in greater Paris (P = 0.0005). Such difference appears only related (P = 0.0008) to the higher prevalence of univentricular hearts. This study demonstrated for the first time a higher prevalence of univentricular hearts in French Guiana which represents the main current cardiac cause of infant mortality. This act as a significant marker of the global burden of complex CHD in this region Furthers studies are required to extend such findings to surrounding countries of South America.

The association between the congenital heart diseases and congenital anomalies of the kidney and the urinary tract in nonsyndromic children.

Several congenital heart diseases (CHD) are present in children with congenital anomalies of the kidney and the urinary tract (CAKUT) in syndromic or nonsyndromic patterns. The purpose of this study was to identify nonsyndromic children with CAKUT who required echocardiographic evaluation and to find the prevalence of CHD in these patients. Retrospective chart review of nonsyndromic patients with CAKUT between 2012 and 2018 was conducted. Types of congenital anomalies of the kidney and urinary tract and echocardiogram reports of the patients, age, gender, prematurity, prenatal diagnosis of CAKUT, and family history were noted. Among 806 children with CAKUT, 135 patients underwent transthoracic echocardiographic evaluation and CHD was detected in 91 (11.2%). The most common type of CHD was secundum type atrial septal defect that was found in 73 (80.2%) patients. On the other hand, the most frequent types of congenital anomalies of the kidney and the urinary tract were isolated hydronephrosis and primary vesicoureteral reflux (61.4% and 12.8%, respectively). Our results showed that 75.8% of the patients with congenital heart diseases had isolated hydronephrosis. Finally, only 18 (2.2%) cases out of 806 patients that were evaluated via transthoracic echocardiography due to the clinical findings and family history had a CHD that required close (<6months) follow-up. Congenital heart diseases that required close follow-up are rarely observed in nonsyndromic patients with CAKUT. Therefore, we suggest echocardiography should be performed in cases of clinical suspicion and family history rather than routinely in this patient group.

Detection and Treatment of Asymptomatic Patients With Congenital Heart Defects in China and Cambodia: Data From an International Screening and Intervention Project

Background: A considerable amount of children and adolescents suffering from asymptomatic congenital heart disease (CHD) were left in community, due to poor health-related resources and consciousness, particularly in low- and middle- income countries. Thus, we aimed to determine the prevalence of asymptomatic CHD in China and Cambodia, as well as to evaluate the gaps in patients' growth status and the effects of the treatment. Methods: In this study, we sampled kindergartens and schools from 8 provinces in China and 5 provinces in Cambodia. In children and adolescents aged 3-18 years, physical signs and heart sounds were examined, then further echocardiography were conducted to detect the CHD that needs treatment. After treatment, patients were followed up for 1 year to assess the gaps in their height and weight to the standard line. Findings: In the 3 068 075 participants screened (3 015 470 in China and 52 605 in Cambodia), 3891 patients with asymptomatic CHD in need of treatment [0·12%, 95% confidence interval (CI) 0·12%-0·13%] were identified. The prevalence of asymptomatic CHD were slightly lower in China than in Cambodia (0·12% vs. 0·16%, p=0·017). Among the 64 screening sites, the county (district) level prevalence of asymptomatic CHD ranged from 0·02% to 0·88%, which were negatively associated with local per capital GDP (p=0·028), but not significantly related with the local average altitude (p>0·05). Among 3310 treated CHD patients, the height was lower than the standard level at their age -2·23% (95% CI: -2·54%~-1·93%, while the weight gap was -6·41% (95% CI: -7·17%~-5·65%), which have been broadening with age of diagnosis. One year after the treatment, the relative gap in height had persisted, and the relative gap in weight had narrowed by 5·68% (95% CI: 4·27%~7·09%), with the “catching-up” steps bigger in patients who were younger at the treatment. The patterns were consistent between the Chinese and Cambodian patients. Interpretation: Asymptomatic CHD still causes notable public health issue in developing countries. Through timely detection and treatment, the potential burden of children and adolescents could be substantially mitigated. Funding Information: This project was supported by the National Key Research and Development Program of China (grant No. 2018YFC1315501), Yunnan Provincial Clinical Research Center Project (Grant No. FZX2019-06-01) and “Love Heart Journey” project. Declaration of Interests: The authors declared no relevant conflict of interest. Ethics Approval Statement: The ethics committee at the Fuwai Yunnan Cardiovascular Hospital approved this project. All patients who received treatment and were followed have provided written informed consent.

Cardiac changes in infants of diabetic mothers.

Diabetes mellitus (DM) is a systemic chronic metabolic disorder characterized by increased insulin resistance and/or β- cell defects. It affects all ages from the foetal life, neonates, childhood to late adulthood. Gestational diabetes is a critical risk factor for congenital heart diseases (CHDs). Moreover, the risk increases with low maternal education, high body mass index at conception, undiagnosed pre-gestational diabetes, inadequate antenatal care, improper diabetes control, and maternal smoking during pregnancy. Maternal DM significantly affects the foetal heart and foetal–placental circulation in both structure and function. Cardiac defects, myocardial hypertrophy are three times more prevalent in infants of diabetic mothers (IDMs). Antenatal evaluation of the cardiac function and structures can be performed with foetal electrocardiography and echocardiography. Postnatal cardiac evaluation can be performed with natal and postnatal electrocardiography and echocardiography, detection of early atherosclerotic changes by measuring aortic intima-media thickness, and retinal vascular changes by retinal photography. Ameliorating the effects of diabetes during pregnancy on the offspring depends mainly on pregestational and gestational diabetes prevention. However, other measures to reduce the risk, such as using medications, nutritional supplements, or probiotics, still need more research. This review discusses the mechanism of foetal sequels and the risk factors that increase the prevalence of CHDs in gestational DM, the various cardiac outcomes of gestational DM on the foetus and offspring, cardiac evaluation of foetuses and IDMs, and how to alleviate the consequences of gestational DM on the offspring.

Congenital heart disease with neonatal revelation in Tunisia: Epidemiological, clinical and evolutionary aspects

Congenital heart diseases include all heart and vascular malformations; they represent around third of congenital malformations and constitute an important public health issue in Tunisia. The aim of this study is to describe the epidemiological and clinical profile of these malformations and to emphasize on the results encountered through the disease treatment. We propose a retrospective study of 165 congenital heart disease observations collected in the neonatology department of the maternity and neonatology center of Tunis over a period of 2 years from January 2018 to December 2019. The hospital prevalence of congenital heart disease was equal to 3.5%. The sex ratio was equal to 1.11 (52.7% male, 47.2% female). Inbreeding was found in 10.9% of patients. The average maternal age was equal to 33 years; the follow-up of the pregnancy was noted in 60.2% of mothers. Chronic diseases were found in 13.3% (type 1 diabetes 6%); 61.2% of heart diseases were diagnosed in antenatal care. Respiratory distress was the most common symptom (86.6%). Hypotrophy was objectified in 11.5% of newborns however the rate of association of heart murmur and congenital heart disease was 45.4%. Among the patients, 28.4% had associated congenital malformations. Non-cyanogenic congenital heart disease represented 63.3%, however, it represented 36.3% for the cyanogenic ones. Among the patients, 67.6% received medical treatment, 12.7% benefited from surgery or interventional surgery and 86.7% of them received treatment in an intensive care setting. The mortality rate was 64.8%. Congenital heart disease is still shown a significant rate of mortality and morbidity. Improving the prognosis is based on prenatal screening in women at risk in order to be able to develop genetic counselling and to practice a therapeutic termination of pregnancy when it is necessary.

The Impact of Maternal Age on the Neonatal Electrocardiogram

Background: Previous studies have suggested an increased prevalence of congenital heart disease among children born to women aged ≥35 years. In recent decades, the mother’s age at childbirth has increased dramatically in industrialized countries. It has not been investigated if increasing maternal age affects the neonatal cardiac electrical system. Methods: The Copenhagen Baby Heart Study is a prospective general population study that performed cardiac evaluation in newborns. Electrocardiograms were analysed with a computerized algorithm. Echocardiograms were obtained using a standardised protocol. Findings: We included 16,518 newborns with normal echocardiograms (median age at examination 11 days; range 0-30 days; 52% boys). Median maternal age at delivery was 31 years; 790 newborns were born to mothers aged between 16-24 years, 11,403 between 25-34 years, 4,279 between 35-44 years, and 46 newborns had mothers aged between 45-54 years. The QRS axis and maximum R-wave amplitude in V1 (R-V1) differed across the four maternal age groups (both p 0.05). Interpretation: We observed a significant association between maternal age and the neonatal QRS axis and R-V1. However, the absolute differences were relatively small and maternal age is unlikely to have a clinical significant effect on the neonatal cardiac electrical system. Funding: The Danish Heart Foundation, The Danish Children Heart Foundation, Snedkermester Declaration of Interest: None to declare. Ethical Approval: This study was approved by the Regional Ethics Committee (H-16001518) and the Danish Data Protection Agency (Isuite 04546, HGH-2016-53)

Pattern of congenital heart diseases among children attending a pediatric cardiology OPD of a tertiary level hospital in West Bengal, India: a retrospective study

Background: Congenital heart disease (CHD) is one of the most common congenital defects worldwide. The prevalence of CHD is low in India mostly due to under detection. The knowledge regarding socio-demographic factors, other congenital anomalies/syndromes and social impacts associated with CHDs in India is grossly lacking.Methods: This was a retrospective study. Details of all diagnosed pediatric (age 0-14 years) cases of CHD were recorded by a single cardiologist from the year 2013 to 2020. Duplicate entries were removed and CHDs were classified according to Q20-Q28 of tenth revision of international classification of diseases (ICD). For description purposes, the CHDs were divided into 10 sub-groups.Results: Total 9247 cases of CHDs were recorded during the study period. Ventricular septal defect was the most commonly identified CHD (32.1%). Most cases were acyanotic (69.8%) and presented first time at age of more than two years. Almost 1.5% cases were associated with other non-cardiac congenital defect or syndrome. In 1.0% of cases either mother or the child faced social or family problem due to the disease.Conclusions: CHD is an emerging public health problem. It is associated with other congenital anomalies/syndrome. Mandatory screening for birth defects needs to be initiated at all birth facilities. At birth counseling of the parents need to be implemented due to the associated social issues.

The Mathematical Limitations of Fetal Echocardiography as a Screening Tool in the Setting of a Normal Second-Trimester Ultrasound

BackgroundThe effectiveness of screening strategies targeting pregnancies at higher risk of congenital heart disease (CHD) is reduced by the low prevalence of severe CHD, the increase in CHD detection rates by second-trimester ultrasound (U/S), and the high proportion of severe CHD in low-risk pregnancies. We aimed to determine situations in which additional screening by fetal echocardiography (FE) would result in a significant increase in sensitivity and a sizable decrease in the false-negative rate of detection of severe CHD. MethodsWe simulated the change in the numbers of detected severe CHD cases when FE is offered to women with a normal second-trimester U/S who have a higher risk of bearing a child with CHD, compared to U/S alone. The primary outcome was the increase in sensitivity. Secondary outcomes were the number needed to screen and the reduction in the rate of missed cases. ResultsFor an U/S sensitivity of 60%, the addition of FE in pregnancies at high risk of CHD (risk ratio 3.5; range: 2 to 5) increased sensitivity by 2.4 percentage points (1.1 to 7.9). The number needed to screen to detect one additional case of severe CHD was 436 (156 to 952). The rate of additional severe CHD cases detected by FE was 4 per 100,000 pregnancies (2 to 32). ConclusionsThe addition of FE to U/S for severe CHD prenatal screening in pregnancies at high risk of CHD yielded marginal benefits in terms of increased sensitivity and decreased rates of false negatives, at the expense of significant resource utilization.

Prevention and Early Detection of Congenital Heart Defects. Where do we stand.

Introduction: Since the origin of Medicine in 4th BC. Century research has taught us that learning and practicing preventive medicine is properly the best method to prevent disease from happening in the first place. Preventive health care must be planned and executed ahead of time, even when illness/ disease, is absent, especially for those that are common and fаtal. Among neonates and infants, congenital heart disease (CHD) is responsible for the largest proportion of mortality caused by birth defects. Actual numbers of patients and mortality resulting from CHD reportedly is increasing. In the developed world the treatment of CHD has escalating costs for health care systems and private covered patients, while in low-income countries it is not always available. Prevention is urgently needed to tackle the increasing needs.&#x0D; Aim: To present the current practice in preventing/early detecting CHD and justify why pulse oximetry is the best available, early detecting postnatal screening test we currently have.&#x0D; Methods: The existing in use preventing/early detecting methods for avoiding or early diagnosing CHD are: 1. Eliminate the maternal risk factors by obtaining a good level of health and medical surveillance during pregnancy. 2. Avoiding teratogenic agents, 3. Detecting risk factors from Family History, 4. Delivering a balanced Nutrition during Pregnancy 5. Obtaining at least an experienced 4-chamber view and outflow tracts imaging during the 20-weeks anomaly scan. 6. Fetal Echocardiography when indicated 7. Postnatal evaluation by experienced Pediatricians. 8. Pulse Oximetry, screening test after 72 hours post-delivery in term babies. 9. Hyperoxia test when indicated.&#x0D; Conclusion: Although CHD’s are the most common, high morbidity and mortality, congenital malformations, we still lack a single, easy to apply, non-invasive and low-cost screening test, for early detection. The current preventive methods must be combined to counterbalance the CHD prevalence. Meanwhile, they are costly and partially accessible. The most advantageous method for minimizing CHD deaths worldwide seems to be currently, pulse oximetry combined with clinical assessment.&#x0D; Original publication: Petropoulos AC. Prevention and Early Detection of Congenital Heart Defects. Where do we Stand. J Cardiol 2018, 2(1): 000111.