[Prevalence and distribution of congenital heart diseases in Indre-et-Loire. Evaluation of prenatal diagnosis (1991-1994)]

[Cardiopathies in children hospitalized at the University hospital Souro Sanou, Bobo-Dioulasso: echocardiographic and therapeutic aspects]

Les cardiopathies de l'enfant déterminent en Afrique un problème de santé publique difficile à prendre en charge, de part la densité de la population jeune, le faible niveau socioéconomique et l'insuffisance de plateaux techniques adaptés. Les auteurs rapportent les aspects échocardiographiques et thérapeutiques des cardiopathies de l'enfant dans le département de pédiatrie du CHUSS de Bobo-Dioulasso. Il s'agissait d'une étude transversale descriptive concernant la période de janvier 2013 à décembre 2014 (24 mois). Elle a consisté en une revue documentaire des comptes rendus d'échocardiographies réalisées chez les enfants de moins de 15 ans dans le laboratoire d'échocardiographie du CHUSS et de leurs dossiers de suivi thérapeutique. Durant la période d'étude, 184 examens écho-cardiographiques avaient été réalisés et permis la mise en évidence de 93 cas de cardiopathies de l'enfant, soit 50,50% des cas. Parmi eux, on distinguait 71% (66/93) de cardiopathies congénitales et 29% (27/93) de cardiopathies acquises. Les cardiopathies congénitales les plus fréquentes étaient : la CIV (27,2%), CIA (10,6%), CAV (7,5%), T4F (9,1%), TAC (6%), formes associées (15%). Les cardiopathies acquises étaient dominées par les valvulopathies rhumatismales (48%), la cardiomyopathie dilatée hypokinétique (33,3%) et la tamponnade péricardite (18,5%). L'indication chirurgicale était posée dans 53,7% (50/93) des cas dont 86% (43/50) de cardiopathies congénitales et 14% (7/50) de cardiopathies acquises. 21% (9/43) des cardiopathies congénitales ont bénéficié d'une chirurgie cardiaque. Aucune cardiopathie acquise d'indication thérapeutique chirurgicale n'avait été opérée. Les cardiopathies de l'enfant sont fréquentes à Bobo-Dioulasso. La conception de stratégies multidisciplinaires associées à une optimisation des moyens devraient améliorer la prise en charge de ces cardiopathies.

The challenge of congenital heart disease worldwide: epidemiologic and demographic facts

Congenital heart disease (CHD) afflicts a large number of children every year. The incidence of CHD is generally considered to be 8 per 1,000 live births. However, this estimate is perhaps inaccurate and does not take into consideration regional differences. A large review of the literature was performed to establish the true incidence of CHD and geographical variations. Data on the incidence of specific lesions and their geographical variation, as well as on mortality from CHD, was also reviewed. Taking into consideration the available data on incidence, mortality, and access to care, the global challenge that CHD represents was analyzed. Insight into how to confront this challenge is given.

[Results of the surgical closure of ventricular septal defects of various ages: report of 30 cases]

OBJECTIVE

To appreciate short and midterm results of patients after surgical closure of the ventricular septal defect.

MATERIAL AND METHODS

The study is retrospective and took place in the department of cardiovascular surgery "B", Ibn-Sina hospital, Rabat, Morocco. Between 1995 and 2005, 30 patients underwent a surgical closure of ventricular septal defect. Eighteen patients (60%) were males and twelve (40%) were females with a mean age of 10 years (18 months-36 years). Seven patients (23%) were older than 16 years. All of ventricular septal defects were type 2, unique and most of them perimembranous (70%). Four patients (13%), were older than 16 years, had a significant aortic insufficiency that has dictated the aortotomy for ventricular septal defect repair. The surgical approach through the right atriotomy was sufficient for complete repair in 22 patients (73%). Closure of the defect has been done using a pericardial autologous patch in 28 patients (93%).

RESULTS

No operative mortality was observed. The mean follow-up was five years. Eight patients (26%) had a residual ventricular septal defect that progressed to spontaneous closure. Two patients (6%) had a residual pulmonary hypertension and two others a moderate aortic regurgitation. The four patients were older than 16 years. Echocardiography showed a significant reduction in left ventricular dimension and systolic pulmonary artery pressure. At last follow-up, 87% of the patients were in NYHA class 1.

CONCLUSION

This study demonstrates that surgical closure of ventricular septal defect ensures a good outcome in short and midterm. Nevertheless, the risk of delayed complications justifies long-term and regular follow-up.

Incidencia de las cardiopatías congénitas en Navarra (1989-1998)

INTRODUCTION AND OBJECTIVES

Congenital cardiopathies are the most common forms of congenital malformation. They occur in between 5.2 and 12.5 in every thousand live births. The aim of this study was to describe the incidence and nature of congenital heart disease in the Spanish region of Navarra during a specified time period (1989-1998).

PATIENTS AND METHOD

The study involved all children with congenital heart disease among the 47 783 born in the region in the specified time period.

RESULTS

The incidence was 8.96 per thousand live births, with 90% having one of the 10 most common types of cardiac malformation. The accumulative percentage diagnosed was 25.3% in the first 24 hours of life, 45% in the first week, 65% in the first month, and 83.1% during the first year. Some 30.8% of cases of congenital heart disease required invasive treatment: 25.4% underwent surgery and 6.4%, cardiac catheterization.

CONCLUSIONS

The incidence of congenital heart disease in Navarra falls within the range reported for developed countries. The level of care provided in this region is good, as demonstrated by existing diagnostic capabilities and treatment provision.

[Duplication of the superior vena cava and other malformations discovered at insertion of a port-a-cath]

We report a clinical case of a persistent left superior vena cava discovered in a 50-year-old female patient when a port-a-cath was inserted. This already seldom malformation was associated with an arteria lusoria and polysplenia with left inferior vena cava with hemiazygos continuation, right-sided stomach, short pancreas, preduodenal portal vein and intestinal malrotation, but without any cardiac abnormalities.

The incidence of congenital heart disease

This study was designed to determine the reasons for the variability of the incidence of congenital heart disease (CHD), estimate its true value and provide data about the incidence of specific major forms of CHD. The incidence of CHD in different studies varies from about 4/1,000 to 50/1,000 live births. The relative frequency of different major forms of CHD also differs greatly from study to study. In addition, another 20/1,000 live births have bicuspid aortic valves, isolated anomalous lobar pulmonary veins or a silent patent ductus arteriosus. The incidences reported in 62 studies published after 1955 were examined. Attention was paid to the ways in which the studies were conducted, with special reference to the increased use of echocardiography in the neonatal nursery. The total incidence of CHD was related to the relative frequency of ventricular septal defects (VSDs), the most common type of CHD. The incidences of individual major forms of CHD were determined from 44 studies. The incidence of CHD depends primarily on the number of small VSDs included in the series, and this number in turn depends upon how early the diagnosis is made. If major forms of CHD are stratified into trivial, moderate and severe categories, the variation in incidence depends mainly on the number of trivial lesions included. The incidence of moderate and severe forms of CHD is about 6/1,000 live births (19/1,000 live births if the potentially serious bicuspid aortic valve is included), and of all forms increases to 75/1,000 live births if tiny muscular VSDs present at birth and other trivial lesions are included. Given the causes of variation, there is no evidence for differences in incidence in different countries or times.