Prevalence Of Congenital Heart Disease Research Articles

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.
 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.
 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.
 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.
 Original publication: Petropoulos AC. Prevention and Early Detection of Congenital Heart Defects. Where do we Stand. J Cardiol 2018, 2(1): 000111.

Remote magnetic navigation for heart rhythm disturbances treatment in patients after surgical correction of congenital heart disease

The prevalence of congenital heart diseases is nine persons per 1000. Sometimes, congenital heart disease needs surgical correction. The long-term postoperative period is often associated with complex heart rhythm disturbances like ectopic or re-entry tachycardia. These cases, in combination with difficult anatomy, results in challenges during interventional treatment. Catheter ablation has been demonstrated as safe and effective in different types of arrhythmia treatments in such patients, including paediatric cohorts. Despite these facts, several important problems regarding using current technologies are still unresolved. Remote magnetic navigation showed good results regarding localisation of arrhythmogenic zones during treatment of complex heart rhythm disturbances. The objective of the present article is to review recently published data in this area and experience of Meshalkin National Medical Research Center in heart rhythm disturbances treatment using remote magnetic navigation in patients after surgical correction of congenital heart disease. Received 28 September 2020. Revised 25 December 2020 г. Accepted 30 December 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Author contributionsConception and study design: A.B. Romanov, A.M. ChernyavskiyDrafting the article: V.V. Beloborodov, А.V. Ponomarenko, E.А. MorzhanaevCritical revision of the article: A.B. Romanov, А.V. Ponomarenko, I.L. Mikheenko, E.А. Morzhanaev, A.G. Filippenko, A.M. ChernyavskiyFinal approval of the version to be published: V.V. Beloborodov, N.А. Yelemessov, А.V. Ponomarenko, E.А. Morzhanaev, A.G. Filippenko, I.L. Mikheenko, A.M. Chernyavskiy, A.B. Romanov

Congenital Heart Disease and Myelomeningocele in the Newborn: Prevalence and Mortality.

Myelomeningocele (MMC) and congenital heart disease (CHD) are independent risk factors for increased morbidity and mortality in the newborn period and each can require significant operations shortly after birth. Few studies have examined the impact of these combined lesions. We sought to examine the incidence of CHD in patients with MMC, and to evaluate length of stay (LOS), hospital charges, and mortality. Using the Texas Inpatient Public Use Data File, ~ 6.9 million newborn records between 1/1999 and 12/2016 were examined. Hospitalizations were classified as MMC without CHD (n = 3054), CHD without MMC (n = 72,266), and MMC with CHD (n = 171). The birth prevalence of CHD with MMC was 0.3/10,000 live hospital births, with 5% of patients with MMC having CHD, and 0.2% of those with CHD having MMC. There was increased LOS in patients with both MMC and CHD (median 15days, IQR 5-31), compared to CHD without MMC (median 6days, IQR 2-20) and MMC without CHD (median 8days, IQR 1-14) and higher total hospital charges (median $95,007, IQR $26,731-$222,660) compared to CHD without MMC (median $27,726, $6463-$118,370) and MMC without CHD (median $40,066, IQR $5744-$97,490). Mortality was significantly higher in patients with MMC and CHD (22.2% compared to 3.1% in MMC without CHD and 4.1% in CHD without MMC). Significance remained when limiting for patients without genetic conditions or additional major birth defects. MMC with CHD in the newborn compared to either CHD or MMC alone is associated with longer LOS, higher charges, and increased mortality.

Trends in the prenatal diagnosis of trisomy 21 show younger maternal age and shift in the distribution of congenital heart disease over a 20-year period.

Prenatal testing has changed greatly over the past two decades, which may affect the diagnosis of congenital heart disease (CHD) in Down syndrome. The present study aimed to analyze changes in the prevalence and distribution of CHD diagnosed via ultrasonography and fetopathology in 462 fetuses with trisomy 21 between two consecutive 10-year periods (1999-2018), as well as the associations between CHDs, ultrasound markers, and extracardiac malformations. Overall, the frequency of cardiovascular malformations in trisomy 21 was 27.7 and 26.5%, and ultrasound identified 70 and 62% of CHDs during these periods. A profound increase in first-trimester ultrasound findings and associated anomalies with CHDs (ventricular septal defect, Tetralogy of Fallot) since 2009 were observed. Second-trimester nonstructural heart abnormalities were associated with ultrasound anomalies (74%) and major extracardiac malformations (42.9%). During both study periods, mothers carrying fetuses with CHD were significantly younger than those without CHD (p = 0.038, p = 0.009, respectively). Comparing the two 10-year periods, there were no changes in the prevalence and detection of CHDs. Trend analysis revealed that, although the frequency of CHD remained stable, the diagnostic spectrum had shifted between the study periods. Detection of nonstructural heart abnormalities necessitates detailed follow-up for cardiac/extracardiac malformations and chromosomal disorders.

What is the significance of hearing a heart murmur during the newborn physical examination?

Background Newborn screening for congenital heart disease (CHD) forms part of the newborn physical examination (NPE) in the UK. However, research has shown that up to 50% of cases of CHD can be missed by this examination. The purpose of this literature review is to investigate the significance of hearing an asymptomatic heart murmur at the NPE in relation to the presence of CHD. Methodology A critical literature review was conducted to answer the research question. The findings were discussed using a narrative synthesis approach. Findings There was considerable heterogeneity of results. The prevalence of murmur in newborns ranged between 0.6%–10.7%. Between 13%–67% of those newborns had some form of CHD, although many had clinically insignificant lesions. Between 2%–9% of newborns with murmurs had a form of critical CHD (CCHD). The ability to discern whether a heart murmur relates to pathology or not improves with experience. No single optimal timing for the NPE was identified. Pulse oximetry was shown to increase sensitivity of screening for CCHD. Conclusion There is a significant increase in the prevalence of CHD when a newborn has a heart murmur, hence referral for diagnostic echocardiography is required when a heart murmur is identified. Pulse oximetry is an important adjunct to newborn screening for CCHD. Some newborns affected by CCHD will not present with murmur at the NPE. Therefore, those caring for newborns during the early days must know the signs and symptoms of CHD so that appropriate medical assistance can be sought.

Prevalence of Congenital Heart Disease among Children in Khorramabad (West of Iran).

Congenital heart disease is among the most common congenital anomalies in pediatrics. The aim of this study was to evaluate the prevalence of congenital heart disease in children in Khorramabad, Iran. This is a descriptive-cross sectional study where all the children diagnosed with congenital heart disease by echocardiography were enrolled to the Shahid Madani Hospital. Patient information was collected by means of a questionnaire. Of 1600 children who underwent cardiac counseling, 9.75% presented congenital heart disease. These were most prevalent among the children of 0-28 days of the age (14.7%) and least in children aged 1 month-1 year. According to this study, atrial (20.3%) and ventricular septal defect (10.5%) were the most common heart defects, respectively. Among signs and symptoms of cardiac disease, 49.1% of children had cyanosis, 89.7% with increased CT (cardiothoracic)-ratio, and 82.7% of had heart murmur. Congenital heart disease was more prevalent in male infants (58%) and 6.6% patients had heart failure and 1.4% had other congenital conditions, such as Down syndrome. According to our findings, atrial and ventricular septal defects are the most common congenital heart anomalies, respectively, in pediatric patients in Khorramabad.

Incidence, pattern and presentation of Congenital Heart Disease in neonates in southern part of Bangladesh

Background: Congenital heart disease (CHD) has already been recognized as one of the important cause of neonatal mortality and morbidity. The reported prevalence of CHD in live newborns tends to vary a lot due to various unrecognizable lesions at birth and lack of technical expertise.
 Aims & objectives: The ultimate aim of this study was to assess the birth incidence and pattern of congenital heart disease (CHD) using echocardiography in babies born in different government and private hospitals and also in different households.
 Results: Overall incidence of congenital heart disease in neonate in this study was 4.9 per 1000 live birth. Mean age of diagnosis was 22.5±4.6 days. Average weight of these neonates was 26.70 gm. 61.5 % neonates were female. 30.8% was preterm. Respiratory distress was the most common clinical presentation (76.9%). The commonest type of congenital heart disease was Ventricular septal defect (VSD) (61.5%). Maternal co-morbidity may have influence. 30.8% mothers had gestational diabetes mellitus. Hypothyroidism, hypertension and maternal infection may have co-relation.
 Conclusion: In this study, we have found that the overall incidence of neonatal congenital heart disease is 4.9 per 1000 live birth. A high index of suspicion and routine neonatal cheek-up may have key role in diagnosis.
 Mediscope Vol. 8, No. 1: January 2021, Page 27-32

Race and Genetics in Congenital Heart Disease: Application of iPSCs, Omics, and Machine Learning Technologies.

Congenital heart disease (CHD) is a multifaceted cardiovascular anomaly that occurs when there are structural abnormalities in the heart before birth. Although various risk factors are known to influence the development of this disease, a full comprehension of the etiology and treatment for different patient populations remains elusive. For instance, racial minorities are disproportionally affected by this disease and typically have worse prognosis, possibly due to environmental and genetic disparities. Although research into CHD has highlighted a wide range of causal factors, the reasons for these differences seen in different patient populations are not fully known. Cardiovascular disease modeling using induced pluripotent stem cells (iPSCs) is a novel approach for investigating possible genetic variants in CHD that may be race specific, making it a valuable tool to help solve the mystery of higher incidence and mortality rates among minorities. Herein, we first review the prevalence, risk factors, and genetics of CHD and then discuss the use of iPSCs, omics, and machine learning technologies to investigate the etiology of CHD and its connection to racial disparities. We also explore the translational potential of iPSC-based disease modeling combined with genome editing and high throughput drug screening platforms.

Extrasystoles in adults with congenital heart disease: treatment options.

The prevalence of congenital heart disease (CHD) is estimated to be almost one in 100 newborns, with > 90% of patients with CHD surviving into adulthood due to medical and surgical advances in recent decades. The rationale for treatment of ventricular premature beats (VPBs) in the general population without underlying structural heart disease is mainly based on the presence of symptoms and/or the risk for developing VPB-induced cardiomyopathy in patients with very frequent VPBs. In CHD, the same general principles apply, but the clinical picture is often more complicated due to the presence of symptoms and/or systolic dysfunction resulting from the underlying heart disease itself. Sudden cardiac death due to ventricular arrhythmias is amajor concern in the CHD population, although its incidence is relatively low (<0.1%/year). Beta-blockers are the first-line medical treatment for CHD patients with VPBs, although no dedicated studies are available on the use of beta-blockers or anti-arrhythmic drugs in patients with CHD for this indication. Catheter ablation has evolved in recent years as an important treatment modality for cardiac arrhythmias, generally showing superior efficacy over medical treatment for most types of arrhythmias. However, recent technological advances have led to improved methods for ablation even in complex underlying anatomical substrates, with possibilities for image fusion between three-dimensional imaging modalities and electroanatomical mapping systems during the procedure. In addition to a discussion of the above, the article also presents two examples of VPB ablation in CHD patients.

Incidence of congenital anomalies in newborns born to mothers with heart disease

Background: Heart disease is seen in 1% pregnancies. Prior studies have either looked at only the prevalence of congenital heart diseases (CHD) in newborns or the congenital anomalies (CA) in babies born to those with chronic medical disorders as a whole. There is only sparse literature looking specifically at their prevalence in mothers with heart disease.Methods: We aimed to study incidence of CAs in newborns born to mothers with heart disease and to study other relevant outcomes like prematurity, low birth weight and intrauterine growth retardation which have significant associations with CAs. The present study was a descriptive study consisting of retrospective and prospective data and consisted of pregnant women with heart disease from 2006 to 2010 and their newborns.Results: 55 pregnant women with their 55 newborns were selected. Among the 55 newborns, 15% babies had congenital anomalies including CHD, 13% had only CHDs. 21% babies with CHDs were born to CHD mothers and none of the mother baby diagnosis was completely concordant. No statistically significant outcome of CA in newborns born to mothers with heart disease was found. No statistically significant associations among low birth weight, prematurity and CAs was found.Conclusions: 15% had congenital anomalies including CHD. No statistically significant outcome of CA in newborns born to mothers with heart disease was found. Since the study population comprised of a small sample size, significant derivations could not be made. Further studies are required in this direction to see if associations are significant.

The Prevalence and Type of Congenital Heart Diseases in Cytogenetic and Monogenic Chromosomal Rearrangements

In this study, it was aimed to investigate the pattern of congenital heart diseases in cytogenetic and monogenic chromosomal rearrangements. The pediatric age group patients who had been followed between January 2009 and December 2014 by the Genetic Department because of their syndromic manner were enrolled in the study. A total of 301 patients with clinical features were evaluated for cardiac diseases. Echocardiography and standard karyotype studies were performed in all patients. Statistically significant difference of congenital heart disease prevalence between numerical and structural chromosomal abnormalities was found in terms of appearance (p < 0.001). Congenital heart diseases prevalence was 62.5% in trisomy 21, 91% in trisomy 18, and 100% in trisomy 13. Fourteen percent of Turner syndrome patients and 8% of patients with other sex chromosome abnormalities had congenital heart diseases. VACTERL association and DiGeorge syndrome were accompanied by congenital heart diseases with the same rate of 73%. Congenital heart diseases prevalence was 50% among the Williams syndrome patients and 42.4% among the Noonan syndrome patients. There was dilated cardiomyopathy in a patient who was diagnosed with Alstrom syndrome. The prevalence of congenital heart diseases in derivative chromosomal anomalies was statistically significantly higher than the other chromosomal abnormalities with the rate of 62.5% (p < 0.001). Complex cardiac malformations are seen in patients with autosomal chromosomal aneuploidies rather than in patients with sex chromosomal aneuploidies and single gene mutations. CHD has been found with a higher rate in patients with derivative chromosome abnormalities compared with the other structural chromosome abnormalities like deletion, inversion, and translocation. We believe that the patients who are diagnosed with derivative chromosomal abnormalities as a result of genetic testing should be considered for cardiac malformations.

Prevalence of congenital heart disease among patients with down syndrome in Southwestern Saudi Arabia.

Background:There is a paucity of data on the prevalence and pattern of congenital heart disease (CHD) among patients with Down syndrome (DS) in Bisha, Saudi Arabia. The aim of the study was to determine the prevalence and patterns of CHD in patients with DS and explore the association of participants’ sex with CHD in DS patients.Methodology:A total of 42 patients with confirmed DS were enrolled in the study. Relevant data were obtained from the patients’ records. The spectrum of CHD was analyzed and classified accordingly. Pearson's Chi-square was used to determine the association of gender with CHD.Results:Approximately 81% of the study participants had CHD. The most common CHD was atrial septal defect (28.5%), followed by ventricular septal defect (25%), patent ductus arteriosus (16%), and atrioventricular septal defect (14.3%). No significant association was found between CHDs and sex.Conclusion:The prevalence of CHD in the study group was consistent with reports from other regions of Saudi Arabia and globally. Participants’ sex was not associated with the occurrence of CHD in DS patients in this study.

Compendium of cardiac diseases among children presenting in tertiary institutions in southern Nigeria: a rising trend

ABSTRACT The burden of children with cardiovascular disease is on a rising trend. These rising trends are enhanced by the development of new technology in the diagnosis of cardiac lesions. This article is aimed at documenting the current trends in the occurrence of cardiac disease among children attending tertiary hospitals in Sothern Nigeria. This is a descriptive study which involved four hundred and thirty-nine (439) children who had cardiac disease confirmed with echocardiography from four health institutions, namely; Niger Delta University, Bayelsa, Nigeria; University of Nigeria Teaching Hospital, Enugu, Nigeria; Triple care hospital, Enugu, Nigeria and; Blessed children hospital, Enugu, Nigeria over a -five -year period from July 2016- July 2020. The prevalence of congenital heart disease was 83.6% and only 16.4% being acquired heart disease. Many of the children with congenital cardiac defects have associated features of Down syndrome (trisomy 21) and the frequency was related to the type of defect; 6.4% (28/439). These features of Down syndrome are seen mainly in children with AV canal defect 33.3% (14/42) and least in children with TOF 2.0% (1/51). Zero-point two nine percent (1/439) had dextro-cardia and 0.2% (1/340) had VACTERAL (ano-rectal malformation) association, 0.2 % (1/439) had cleft lip, 1.8% (8/439) had dysmorphism other than down syndrome. Five 62.5% (5/8) of such dysmorphic features were associated with VSD.The majority of the children with cardiac disease were from the middle class 63.6% followed by the higher class 21.9% and the least is from the lower class 14.5%. The prevalence values of heart disease were quite higher than that documented in previous studies.The is a rising prevalence of congenital heart disease (83.6%) and acquired heart disease (16.4%) among children with cardiac disease in southern Nigeria. Extracardiac anomalies were also associated with these trends.

Pattern of Cardiac Abnormalities in Children &amp;lt; 5 Years of Age - Experience in a Tertiary Care Hospital

<i>Background</i>: Congenital heart diseases (CHDs) are the most common birth defects, responsible for nearly one-third of all congenital birth defects. The birth prevalence of CHD is reported to be 8-12/1000 live births. Early diagnosis of Congenital as well acquired heart diseases are of paramount important for timely management plan and intervention and thus reduce the mortality and morbidity of childhood heart disease patients. <i>Method</i>: This is a prospective observational study carried out during January 2020 to December’ 2020 at Dhaka Shishu Hospital, Bangladesh. The study population were 100 enrolled cardiac Children who were clinically suggestive of having cardiac disease evaluated through chest X-ray, ECG, Echocardiography and other necessary Investigation. Proper informed consent was taken under the study and purpose of the study was explained. Ethical approval was obtained from the Institutional Ethics Committee. All data were processed, analyzed, and disseminated by MS Office and SPSS version 26 as per need. <i>Results</i>: Among the 100 enrolled cardiac patient 87 were diagnosed to have congenital heart disease and remaining 13% percent presented with acquired heart disease. Out of 87 patients suffering from congenital heart disease 59 (67.81%) had acyanotic heart disease where Ventricular septal defect (VSD) is in the top of the list 27 (31.34%). Cyanotic congenital heart disease was found in 28 (32.19%) where Tetralogy of fallot (TOF) was the most common lesion 9 (10.34%). <i>Conclusion</i>: Childhood Heart diseases are responsible for a significant number of mortality and morbidity. Earlier detection and timely initiative regarding medical or surgical management is of utmost importance to avoid complications, reduce mortality and improve quality of life.

Clinical Profiles, Congenital Heart Disease, and Other Comorbidities Among Egyptian Children with Down Syndrome: A Tertiary Center Study

Abstract Introduction Down syndrome (DS) is the most common chromosomal disorder. It is accompanied by several comorbidities, which could lead to severe morbidity and mortality. Congenital heart disease (CHD) is one of the most commonly described condition. Objective This study aimed to determine clinical profiles, dysmorphic features, CHD, and DS associated comorbidities in a tertiary center (Cairo, Egypt). Patients and Methods This descriptive study included 290 patients diagnosed with DS, who presented to the Clinical Genetics clinic, Cairo University Children Hospitals, from February 2018 to December 2019. The patients' ages ranged from 2 to 4 years old. All patients were evaluated by full history, clinical examination, anthropometric measurements, and assessment of developmental milestones. Patients' diagnostic investigations including karyotype, thyroid function, and echocardiography were checked. Results The study population consisted of 290 children with DS of which 196 (67.6%) were male, 115 (40%) had CHD, the most prevalent atrial septal defect (ASD), patent ductus arteriosus (PDA), and ventricular septal defect (VSD) accounting for 10.7, 7.1, and 4.2%, respectively. Common dysmorphic features were upward slanting palpebral fissures (98.6%), hypertelorism (97.9%), and sandal gap (60.7%). Thyroid dysfunction was the second prevalent comorbidity, found in 35 patients (12.1%). Global developmental delay was reported affecting language (99%), motor (94.8%), and social (92.8%) domains. Conclusion The prevalence of CHD among children with DS was 40% with ASD, PDA, and VSD being the commonest. Thyroid dysfunction was the second most common comorbidity. The most prevalent dysmorphic features were upward slanting palpebral fissures, hypertelorism, and sandal gap. Developmental delay was very common, language being the most affected domain.

Prevalence and Spectrum of Complex Congenital Heart Disease in the Neonatal Intensive Care Unit at High Altitude in China

Background: Previous studies from high altitudes have reported significantly higher prevalence of congenital heart disease (CHD), consisting almost solely of simple CHD. Little is known about the occurrence of complex CHD. Neonates with complex CHD are likely admitted to NICU. We examined the prevalence and spectrum of complex CHD in NICU in order to depict a truer picture of CHD at high altitude. Methods: We reviewed charts of 4,214 neonates admitted to NICU in Qinghai province (average altitude 3,000 m). Echocardiography was performed in 1,943 babies when CHD was suspected based on clinical examinations. Results: CHD was diagnosed in 1,093 (56.3% of echoed babies). Mild CHD in 96.8% (1058 babies). Moderate CHD in 0.8% (9) included 1 (0.1%) large secundum atrial septal defect, 3 (0.3%) moderate pulmonary stenosis, 2 (0.2%) aortic stenosis and 3 (0.3%) partial anomalous pulmonary venous connection. Severe CHD in 2.4% (26) included 6 (0.5%) complete atrioventricular septal defect, 5 (0.5%) complete transposition of the great arteries, 5 (0.5%) hypoplastic right heart, 3 (0.3%) hypoplastic left heart, 3 (0.3%) double outlet right ventricle, 3 (0.3%) tetralogy of Fallot, 2 (0.2%) truncus arteriosus, 2 (0.2%) total anomalous pulmonary venous connection, 2 (0.2%) severe aortic stenosis, 2 (0.2%) interrupted aortic arch and 2 (0.2%) severe pulmonary stenosis and 1 (0.1%) single-ventricle abnormality. At two-years follow-up in 737 (67.4%) patients, 18 (90%) with severe CHD and 38 (5.3%) with mild and moderate CHD died, and 15 underwent cardiac surgery with 1 early death. Conclusions: At high altitude, a wide spectrum of CHD exists, with many heretofore unreported complex CHD. There is urgent need for routine echocardiography and early interventions in newborns particularly in NICU.

There is a Strong Association between Early Preeclampsia and Congenital Heart Defects: A Large Population-Based, Retrospective Study

Objective: The aim of this study was to determine the prevalence of congenital heart defects and examine their association with preeclampsia (PE). Methods: A clinical-based, retrospective study was conducted in Shenzhen between 2004 and 2017. Data were collected from Shenzhen Maternal and Child Health Hospital Medical Record Database. This study included all infants who were born at the hospital with or without heart defects and their mothers (N = 177,434 newborns). Data processing and analysis were performed by SPSS23.0 (Chicago, IL, USA). Results: 6,852 women (3.9%) were diagnosed as PE and 1,289 newborns (7.30 per 1,000) have congenital heart disease (CHD). Prevalence of CHD in newborns of women with PE is 15.8 per 1,000 significantly higher than the overall prevalence (7.30 per 1,000). CHD in newborns has strong association with PE, especially early-onset PE (adjusted OR 3.29 and 95% CI 2.15–5.03) and severe PE (adjusted OR 2.75 and 95% CI 2.13–3.56). Among those with CHD, infants of preeclamptic women had higher prevalence of tetralogy of Fallot (43.78 vs. 28.14 per 100,000), atrial septal defect (335.67 vs. 53.93 per 100,000), ventricular dysplasia (102.16 vs. 89.69 per 100,000), and ventricular septal defect (525.39 vs. 212.22 per 100,000) than pregnant women with non-PE. Conclusion: PE, especially early-onset PE and severe PE, is strongly associated with offspring CHD. Our results help advance the current understanding of the association between PE and offspring CHD. So preventing PE and reducing PE may have a beneficial effect on the offspring CHD.

Congenital Heart Disease in Dogs: A Retrospective Study of 95 Cases

The aim of the study was to estimate the prevalence of congenital heart diseases in dogs attending 2 veterinary hospitals in Brazil and to identify possible associations between these conditions and epidemiological characteristics.A retrospective study was carried out in the cardiology sections of 2 veterinary hospitals during a period of 70 months from January 2012 and October 2017.Of a total of 6710 dogs that attended the cardiology sections of the hospitals, 109 congenital heart diseases were identified in 95 patients, representing a prevalence of 1.6%. Findings consistent with previous literature included subaortic stenosis and pulmonic stenosis as the most commonly diagnosed conditions, in addition to a higher predisposition of females to patent ductus arteriosus (PDA). In contrast, the novel findings included a higher prevalence of atrial septal defect and a lower prevalence of patent ductus arteriosus. The majority of the animals included were over 1 year of age at the time of diagnosis (67%) especially in the subaortic stenosis group. Also, a predisposition of the Maltese to ventricular septal defect was observed.The information obtained in the present study contributes to research that describes epidemiological characteristics of dogs with congenital heart disease in a previously unreported location.

The screening of congenital heart disease by cardiac auscultation and 12-lead electrocardiogram among Indonesian elementary school students.

Screening for congenital heart disease (CHD) in school students is well-established in high-income countries; however, data from low-to-middle-income countries including Indonesia are limited. This study aimed to evaluate CHD screening methods by cardiac auscultation and 12-lead electrocardiogram to obtain the prevalence of CHD, confirmed by transthoracic echocardiography, among Indonesian school students. We conducted a screening programme in elementary school students in the Province of Special Region of Yogyakarta, Indonesia. The CHD screening was integrated into the annual health screening. The trained general practitioners and nurses participated in the screening. The primary screening was by cardiac auscultation and 12-lead electrocardiogram. The secondary screening was by transthoracic echocardiography performed on school students with abnormal findings in the primary screening. A total of 6116 school students were screened within a 2-year period. As many as 329 (5.38%) school students were detected with abnormalities. Of those, 278 students (84.49%) had an abnormal electrocardiogram, 45 students (13.68%) had heart murmurs, and 6 students (1.82%) had both abnormalities. The primary screening programme was successfully implemented. The secondary screening was accomplished for 260 school students, and 18 students (6.9%) had heart abnormalities with 7 (2.7%) who were confirmed with septal defects and 11 (4.2%) had valve abnormalities. The overall prevalence was 0.29% (18 out of 6116). The primary screening by cardiac auscultation and 12-lead electrocardiogram was feasible and yielded 5.38% of elementary school students who were suspected with CHD. The secondary screening resulted in 6.9% confirmed cardiac abnormalities. The cardiac abnormality prevalence was 0.29%.