Transcript freq. cardiac disease in Lao PDR (1)x

Presented by Malouny SISAVANH, MD
Summary of Cases
• From 2013-07-12 to 2013-11-19
• Total 140 cases (including repeated or follow-up exams)
- CHD: 33 cases
Average: 1.5 case/day
- Others: 29 cases
*
†
* Repeated or follow-up exams included.
† “Others” indicates any acquired cardiac problems from infectious,
degenerative, and atherosclerotic causes.
Summary of Cases
• From 2013-07-12 to 2013-11-19
• Total 115 patients (excluding repeated or follow-up exams)
- CHD: 25 patients
- Others: 12 patients
*
†
* Repeated or follow-up exams excluded.
† “Others” indicates any acquired cardiac problems from
infectious, degenerative, and atherosclerotic causes.
Indication of Test
Indication
Number (%)
Routine check-up
(including preoperative evaluation)
19 (16.5%)
Cardiac murmur
11 (9.6%)
CXR abnormality
(Cardiomegaly / Pulmonary edema
/ Pleural effusion / Etc)
4 (3.5%)
Dyspnea / Hypoxemia / Heart Failure
13 (11.3%)
Suspicious of Congenital Heart Disease
(Specific indications were not provided)
21 (18.3%)
Suspicious of Kawasaki Disease
5 (4.3%)
Suspicious of Infective Endocarditis
3 (2.6%)
Suspicious of Diphtheric Myocarditis
1 (0.9%)
Chest pain
7 (6.1%)
Palpitation / Arrhythmia
14 (12.2%)
Fatigue / Dizziness
13 (11.3%)
Peripheral edema
2 (1.7%)
Unspecified
2 (1.7%)
Total
115 patients (100.0%)
Details of Patients
CHD
Number
Others
Number
PDA
6
Cardiac tamponade
1
ASD
4
Uremic cardiomyopathy
2
VSD
3
1
ASD + PDA
3
Coronary aneurysm
(due to history of KD)
ASD + VSD
3
Kawasaki disease
1
PDA + Bicuspid AoV
1
Ischemic cardiomyopathy
1
ASD + VSD + PDA
1
Diastolic Heart Failure
1
Severe TR + ASD + VSD
1
Rheumatic MSR with ASR
1
AVSD
1
Pericardial effusion
2
TOF
1
Infective endocarditis
1
Total
25 patients
Diphtheric myocarditis
1
Total
12 patients
Important Features
1. Undiagnosed and Unrepaired Congenital Heart
Diseases are common in Adolescents or Adults
2. Cyanotic or Complex Congenital Heart Diseases
are Rare
 Insufficient neonatal screening
 Lack of knowledge (patients / physicians)
 Limited hospital accessibility
Problems
1. Referral for Surgery is Limited
–
–
–
Cardiac surgery is available only in Mahosot Hospital, performed by foreign
volunteer doctors (from western countries)
No cardiac surgery team in the Children’s Hospital
Post-operative outcome is unknown
2. Lack of Sedation System
– EchoCG in the Children’s Hospital: Time- and Effort-consuming work
3. Economic and Social Situation
– Patients/Parents cannot afford medical/surgical costs
4. Lack of Pathologic / Microbiologic / Serologic Laboratories
–
Routine laboratory tests are impossible or limited
Acknowledgement
• In-Chang Hwang, M.D (KOICA volunteer doctor in children’s hospital)