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Prevalence of VSD, PDA, and ASD in Saudi Arabia by Echocardiography: A Prospective Study

Authors

  • Dr. Rana Eisa
  • Dr. Mahmoud S. Babiker

Theme

Diagnostic & Interventional Radiology

INSTITUTION

King Saud University
Taibah University, Al-Madinah AlMunawarah, Kingdom of Saudi Arabia

Background

Congenital heart disease (CHD) is a major health problem in newborns and children. Studies have shown that CHD is a common cause of perinatal morbidity and mortality.1,2 CHD is responsible for approximately 4.0% of all neonatal deaths worldwide.3 Epidemiological studies indicate a worldwide prevalence ranging from 8.0 to 12.0 per 1000 live births.4,5 The ideally suitable imaging technique is echocardiography due to wide range of imaging planes which allow the demonstration of cardiac structures anatomical relationships that can aid in the diagnosis of simple and complex congenital malformations ( Feigenbaum et al,2005).Acyanotic congenital lesions account for 70% of all congenital heart disease, the most common of which, as isolated lesions, are ventricular septal defects (most common), patent ductus arteriosus, atrial septal defect and pulmonic stenosis (Keith JE et al ,1967).Acyanotic congenital lesions account for 70% of all congenital heart disease, the most common of which, as isolated lesions, are ventricular septal defects (most common), patent ductus arteriosus, atrial septal defect and pulmonic stenosis (Keith JE et al ,1967).

Summary of Work

 A descriptive prospective study was conducted at   King Fahad Cardiac Center- Pediatric Cardiology Unit- King Khalid University Hospital -KSU-Riyadh –KSA. Pediatric patients were enrolled in the study if they exhibited one or more of the following: cardiomegaly, large pericardial effusion, or heart murmur grades 4 to 6. A Philips iE33x Matrix echocardiography system with an X-Matrix Cardiac Transducer x5-1 (Phillips Medical Systems, Bothell, Washington) was used to evaluate each participant. An echocardiographic examination, including 2D B-mode imaging along with color, pulse, and continuous wave Doppler imaging, was performed on each patient.The participants were classified into four age groups (<1 month, 1 month to <1 year, 1 year to <5 years, and 5–11 years).The Statistical Package for Social Sciences version 16.0 (SPSS, Inc., an IBM Company, Chicago, Illinois) software was used to analyze the data. 

 

Summary of Results

In total, 356 patients were enrolled in the study and underwent a standard comprehensive echocardiographic evaluation. These data were tested for associations with patient demographic data. Multiple CHD manifestations were noted (n = 446), with PDA (47.47%) most common, followed by ASD (41.85%) and VSD (28.9%). A statistical association was noted between PDA and patient age (P < .00) as well as ASD and female sex (P < .00). PDA was the most frequent of all CHDs manifestations. 

Conclusion

The study found that PDA was the most common CHD and that PDA and ASD were more prevalent among female patients. A significant association between ASD and the female sex was found (P = .000). Membranous VSD and ostium secundum ASD were the most common types of CHDs, and they were more frequent in the one- to five-year-old age group. This study revealed that ASD is more prevalent in patients with heart murmurs. This was a cohort study; therefore, these results would need to be confirmed with continued research in this region.

Take-home Messages

Careful evaluation and early diagnosis of CHD in high-risk group are highly indicated. As advanced tools of diagnosis have come up . There is a need for development of prenatal screening programs for CHD in our population so as to provide better medical care and improved outcomes in the region.

Acknowledgement

The researchers send their gratitude and appreciation to the King Fahad Cardiac Center, King Khalid Hospital, Riyadh, KSA for the opportunity to conduct this study.

References

1. Gilboa SM, Salemi JL, Nembhard WN, Fixler DE, Correa A: Mortality resulting from congenital heart disease among children and adults in the United States, 1999–2006. Circulation 2010;122:2254–2263. 2. Yang Q, Chen H, Correa A, Devine O, Mathews TJ, Honein MA: Racial differences in infant mortality attributable to birth defects in the United States, 1989–2002. Birth Defects Res A Clin Mol Teratol 2006;76:706–713. 3. Molaei A, Asadi G, Khoshbakht M: Prognosis of the newborns with congenital heart diseases. Adv Biosci Clin Med 2015;3(3):50–55. 4. Linde DVD, Konings EE, Slager MA, et al: Birth prevalence of congenital heart disease worldwide. J Am Coll Cardiol 2011;58(21):2241–2247. 5. Qu Y, Liu X, Zhuang J, et al: Incidence of congenital heart disease: the 9-year experience of the Guangdong Registry of Congenital Heart Disease, China. PLoS ONE 2016;11(7):e0159257.6. Cawyer CR1, Kuper SG1, Ausbeck E1, Sinkey RG1,Owen J1: The added value of screening fetal echocardiography after normal cardiac views on a detailed ultrasound. Prenat Diagn: 1148-1154. doi: 10.1002/pd.5557. 

 

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Background

Summary of Work
Summary of Results

 

Figure 1. A one-day, female 2D echocardiogram and color flow Doppler confirmation of left ventricle to right ventricle shunt in muscular ventricular septum defect (VSD). Note the jet from the left to right ventricle across the VSD (arrows).‚Äč

Figure 2. A 2D echocardiogram of a 13-month-old male patient, demonstrating a large patent ductus arteriosus (31 mm; arrow) with a color flow Doppler confirmation (arrowhead). AO, aorta; LA, left atrium; LPA, left pulmonary artery; PA, pulmonary artery; PDA, patent ductus arteriosus; RA, right atrium; RPA, right pulmonary artery; RV, right ventricle.

Figure 3. Apical four-chamber view for six days, female patient, demonstrating a large ostium primum atrial septum defect (84 mm; arrowhead) and inlet ventricular septum defect (34 mm; arrow). ASD, atrial septum defect; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; VSD, ventricular septum defect.

Conclusion
Take-home Messages

Problem of the study

Pediatrics Acyanotic Congenital Cardiac Malformations account about 70% of all congenital cardiac defects. The concern over these defects is necessitated by the fact that, although most of these lesions commonly are of no impact on patients, but a number of them can have grave outcome if clinical evaluation report did not herald this fatality, because some patients may be asymptomatic which will lead to delayed diagnosis. So neonates, infants, and children's;  merit further evaluation by another diagnostic , reliable, accurate  tool ;echocardiography. 

Acknowledgement
References
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