Transcript Spectrum of congenital heart diseases in Meghalaya

Spectrum of congenital heart
diseases in Meghalaya –A Hospital
based study
Sourabh Gohain Duwarah*. Dhrubajyoti Sharma*,
Rashna Dass**, Ajit Chhetri**, Pankaj Jain*, Bhaskar
Saikia*, Himesh Barman*,
(*Senior Resident, **Assistant Professor)
Department of Pediatric Disciplines, North Eastern
Indira Gandhi Regional Institute of Health and Medical
Science (NEIGRIHMS), Shillong.
Introduction
• Congenital heart disease (CHD) refers to
structural or functional heart disease that is
present at birth even if it is discovered much
later
• CHD: Occurs in approximately 8/1000 live
births.
• No available data on prevalence of CHD from
Meghalaya
Aims and objectives
• The present study was conducted
to ascertain the spectrum of
Congenital heart disease in
Meghalaya (0 to 18 years old).
Material and methods
• Study design: Retrospective study from Jan’05 to June’07 (2.5 years).
• Place of study: Dept. of Pediatric Disciplines,NEIGRIHMS,Shillong.
• Age group: 0 to 18 years of age.
• Data on congenital heart diseases were collected in semi structured
proforma and analysed.
• The source of information was all outpatient and inpatient records
including echocardiography records from Jan’05 to June’07
• Exclusion criteria included CHDs with associated syndromes,
since the present study was to know the prevalence of isolated
CHDs in Meghalaya.
Results and observations
• Total no of cases seen
during study period:
12,322.
• Congenital heart
disease: 286(2.32%).
2.32%
Total no of
cases seen
during study
period
Cases of CHD
Results- No. of referred cases
Pie diagram showing percentage of the
referred cases
Thirty two
percent(32%)cases
were referred cases.
32%
referred cases
not referred cases
68%
Results- Distribution of cases during the
study period
Distribution of cases during the study period
100
90
80
70
60
50
40
30
20
10
0
91(31.81)
69(24.12)
52(18.18)
46(16.08)
28(9.79)
JanJune'05
JulyDec'05
JanJune'06
JulyDec'06
JanJune'07
Cases increased from 9.79% in Jan-June’05 to 31.81%
in Jan-June’07.
Results- age wise distribution
30
26.92
25
20
15
13.28
10.48
9.09
10
6.99
5
4.89
4.19
1.39
Maximum cases were diagnosed during infancy(26.92%)
followed by second year(13.28%) of life.
18th yr
17th yr
16th yr
15th yr
14th yr
13th yr
12th yr
11th yr
10th yr
9th yr
8th yr
7th yr
6th yr
5th yr
4th yr
3rd yr
2nd yr
1st yr
0
Results – various CHDs observed
in the present study
Congenital heart
disease (CHD)
Total no of cases
Percentage(%)
Ventricular septal
defect (VSD)
136
47.55
Atrial septal defect
(ASD)
67
23.52
Patent ductus
arteriosus (PDA)
37
12.93
Tetralogy of fallot
(TOF)
23
8.04
Pulmonary stenosis
(PS)
7
2.44
Endocardial cushion
defect (ECD)
4
1.39
Results-various CHDs observed in the
present study
CHD
Total no of
cases
Percent(%
)
Aortic stenosis (AS)
3
1.04
Bicuspid aortic valve (BAV)
2
0.6
Complex CHD (cyanotic)
2
0.6
Coarctaion of aorta (CoA)
1
0.35
Double outlet right ventricle
(DORV)
1
0.35
Transposition of great arteries
(TGA)
1
0.35
PDA with AS
1
0.35
Tricuspid atresia (TA)
1
0.35
Results- sex wise prevalence of
CHD
46%
Male
Female
54%
The present study shows that, 131(46%) male and
155(54%) female children had CHD.
Results– sex wise distribution
80
70
73
63
Male
60
Female
50
38
40
29
30
24
20
13
13
10
10
3
4
2
2
0
VSD
ASD
PDA
TOF
PS
5 4
3
0
ECD
AS
others
VSD
ASD
PDA
TOF
PS
ECD
AS
Others
Male
63(46.32)
29(43.28)
13(35.13)
13(56.52)
3(42.85)
2(50)
3(100)
5(3.81)
Female
73(53.67)
38(56.71)
24(64.86)
10(43.47)
4(57.14)
2(50)
0
4(2.58)
Results-prevalence of acyanotic CHD
Among the acyanotic CHDs most common was VSD(53%)
followed by ASD(26%) and PDA(14%).
Results- prevalence of cyanotic CHD
Among the cyanotic group most common was TOF(81%).
Prevalence of major types CHDs in
the available literature & its
comparison to the present study
Place
VSD(%)
ASD(%)
PDA(%) TOF(%)
Present study
47.5
23.5
12.9
8
India (1971)
29
12
11
17
UK (1981)
32.5
5.9
11.9
5.9
USA (1990)
32.1
7.4
8.3
3.8
Japan (1990)
60
5.3
3.6
5.8
Egypt (2000)
35.3
13.6
6.1
5
S.Arabia (2001)
39.5
11.5
8.6
4.2
Comparision of prevalence of CHD in
the present study with studies in south
India and Punjab.
3.50%
3%
3.00%
2.50%
2.50%
2.32%
2.00%
1.50%
1.00%
0.50%
0.00%
Present study
South India
Punjab
Analysis revealed a prevalence of CHD 2.32% which was not as high as
other parts of the country.
Comparison of the prevalence of
major CHDs in different studies in
India.
Name of the
CHD
Present study
(n=286)
(Jan’05-June’07)
Study by Smitha R et al
in mysore (n=500)
(2000-2004)
Study by L.Kasturi et
al in Mumbai (n=108)
VSD
136(47.55)
242(40.47)
29(27)
ASD
67(23.52)
114(19.06)
26(24)
PDA
37(12.93)
57(9.53)
7(6)
TOF
23(8.04)
80(13.38)
10(9)
Discussion contd…
• The frequency of rare types of CHDs like
AS,PS, TGA,TA,ECD were less in the present
study.
• Most of the CHDs were diagnosed during
infancy(26.92%) which was in accordance
with the other studies.
• Prevalence was slightly higher in females as
compared to the males.
Discussion contd…
• The prevalence of CHDs in the study was
increasing from 2005 to 2007 (9.79% in JanJune’05 to 31.81% in Jan-June’07).
• Increasing number of OPD visits,
improvement of diagnosis, attention or
awareness among the referring
government / private sector doctors might be
the causes for the increase.
Conclusion
The present findings indicate that,
(a) Prevalence of CHDs in Meghalaya is not as
high as the prevalence reported by other Indian
studies.
(b) However, it is an important disease which
requires immediate attention and highlights
the need for appropriate cardio-thoracic
surgical services accessible to the common
man in this region .
Thank you…
Thank
you
Thank you