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 Table of Contents  
ORIGINAL RESEARCH ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 3  |  Page : 105-109

Spectrum of congenital heart diseases and its correlation with maternal risk factors


Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Date of Submission07-Dec-2020
Date of Decision25-May-2021
Date of Acceptance31-May-2021
Date of Web Publication30-Jun-2021

Correspondence Address:
Dr. Velam Vanajakshamma
Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati - 517 507, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpai.jpai_30_20

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  Abstract 


Objectives: The present study was sought to determine the spectrum of congenital heart diseases (CHDs) and their correlation with maternal risk factors at a tertiary care hospital situated in sub-urban area. Materials and Methods: This cross-sectional, observational study was conducted from February 2019 to February 2020. A total of 100 children suspected for CHD were screened and 67 confirmed CHD cases were enrolled into the study. Children having cardiomyopathy, rheumatic heart disease, secondary heart disease, and asymptomatic children were excluded from the study. Detailed history of presenting complaints, pregnancy, family history, consanguinity, and socioeconomic status was documented. Chest X-ray, electrocardiogram, and echocardiography were done to arrive at a definitive diagnosis. All the statistical analyses were performed using the SPSS software version 20.0 (IBM Corp, Somers, NY, USA). Results: Majority of the children presented with symptoms in the age group of 1–5 years. Most of the parents of children with CHD were educated up to secondary educational level (34%) followed by illiterate (24%). Economic status of most of the parents was upper lower class (67%). Maternal risk factors were not observed in 60% (n = 40) of the cases. 41.79% of CHD children were born to consanguineously married couple. Maternal stress was present in 40% of the cases. The most common presenting complaint was lower respiratory tract infection (LRTI in 61%). Murmur was seen in 70% (n = 47) of the cases. Majority of the cases (84%) were acyanotic and cyanosis was present in 16% of the cases. Atrial septal defect (ASD) was the most common which constituted 44.6% in acyanotic heart disease while tetralogy of Fallot (TOF) was the most common with 18.1% in cyanotic heart disease. In both cyanotic and acyanotic CHD groups, majority of the cases had no maternal risk factors (45.5% and 62.5%, respectively). Conclusion: The most common types of CHDs in acyanotic and cyanotic CHD groups are ASD and TOF, respectively. Consanguinity, stress during pregnancy, and diabetes mellitus were identified as the major risk factors for CHD. LRTI and shortness of breath were the most common clinical features in children with CHD.

Keywords: Children, congenital heart disease, maternal risk factors, South India, Tirupati


How to cite this article:
Vakkala C, Patan SM, Kasala L, Vanajakshamma V, Durgaprasad R. Spectrum of congenital heart diseases and its correlation with maternal risk factors. J Pediatr Assoc India 2020;9:105-9

How to cite this URL:
Vakkala C, Patan SM, Kasala L, Vanajakshamma V, Durgaprasad R. Spectrum of congenital heart diseases and its correlation with maternal risk factors. J Pediatr Assoc India [serial online] 2020 [cited 2023 Jan 30];9:105-9. Available from: http://www.jpai.in//text.asp?2020/9/3/105/320122




  Introduction Top


Congenital heart disease (CHD) is defined as an abnormality in cardio circulatory structure or function that is present at birth, even it is discovered much later.[1],[2],[3] The majority of congenital anomalies of the heart is present 6 weeks after conception, and most anomalies compatible with 6 months of intrauterine life permit live offspring at term. The CHDs are not fixed anatomic defects that appear at birth but are instead a dynamic group of anomalies that originate in fetal life and changes considerably during the postnatal development.[4]

The incidence of moderate-to-severe structural CHD in live born infants is 6–8 per 1000 live births.[5],[6], [7,[8] This incidence has been relatively constant over the years and in the different parts of the world.[9] More recent, higher incidence figures appear to be due to the inclusion of more trivial forms of CHD, such as tiny ventricular septal defects that are detected more frequently by highly sensitive echocardiography.[6]

Congenital cardiac defects have a wide spectrum of severity in infants. About 2–3 in 1000 newborn infants will be symptomatic with heart disease in the 1st year of life. The diagnosis is established by 1 week of age in 40%–50% of patients with CHD and by 1 month of age in 50%–60% of patients. With advances in both palliative and corrective surgery in the last 20 years, the number of children with CHD surviving to adulthood has increased dramatically.[10] Most congenital defects are well tolerated in the fetus because of the parallel nature of the fetal circulation.[10]

Depending upon the severity, CHD presenting at birth can be categorized into three groups – mild, moderate, and severe categories. Severe CHD includes all cyanotic lesions as well as acyanotic lesions, which require intervention early in life. Moderate CHD is those that require expert care but less intensive compared to severe CHD. Mild CHD is asymptomatic and often undergo spontaneous resolution.[11] Signs and symptoms of severe CHD in the newborn period include cyanosis, discrepant pulses and blood pressures, congestive heart failure, and cardiogenic shock.

The initial evaluation of any newborn suspected of having critical CHD includes a through physical examination, four extremity blood pressures, preductal and postductal saturations, a hyperoxia test, a chest radiograph, electrocardiogram (ECG), and an echocardiography.[12]

Thus, recognition of CHD in the newborn is important as these groups of abnormalities constitute a significant proportion of congenital malformation that present in neonatal life, and their early detection is important for appropriate management, and short-term follow-up for decision-making regarding referral or waiting. The present study was sought to determine the spectrum of CHDs and their correlation with maternal risk factors in a tertiary care hospital situated in sub-urban area.


  Materials and Methods Top


This is a cross-sectional, observational study conducted from February 2019 to February 2020 at department of cardiology, SVIMS, Tirupati. One hundred children who attended the cardiology outpatient department with suspected cardiovascular and respiratory problems were screened. Among them, 67 cases were confirmed with CHDs and are enrolled into the study.

Inclusion and exclusion criteria

Children from newborn to 12 years of age with echocardiographic proof of CHD were included in the study. Children having cardiomyopathy, rheumatic heart disease, secondary heart disease, and asymptomatic children were excluded from the study.

Detailed history of presenting complaints, pregnancy, family history, consanguinity, and socioeconomic status as per the modified Kuppuswamy classification were taken as per the pro forma designed for the study. Relevant investigations such as chest X-Ray, ECG, and echocardiography were done to arrive at a definitive diagnosis.

Data analysis

Data were collected on predefined case record forms and transformed into Microsoft Excel spreadsheet. All the entries were double checked to minimize the possible data entry errors. Data were expressed as mean with standard deviation and frequencies with percentages for continuous and categorical variables, respectively. All the statistical analyses were performed using the SPSS software version 20.0 (IBM Corp, Somers, NY, USA).


  Results Top


The results were conceived from 67 children confirmed with CHD. Among them, 38 (57%) were male and 29 (43%) were female. Majority of the children presented with symptoms in the age group of 1–5 years [Figure 1].
Figure 1: Age-wise distribution of the children. mo: Months; yr: Year; yrs: Years

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Most of the parents of children with CHD were educated up to secondary educational level (34%) followed by illiterate (24%) [Table 1]. Economic status of most of the parents of children with CHD was upper lower class (67%) followed by lower middle class (18%), upper middle class (10%), and upper class (4%), respectively.
Table 1: Educational status of the parents of children with congenital heart disease

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Maternal risk factors

Maternal risk factors were not observed in 60% (n = 40) of the cases. Maternal diabetes mellitus, maternal obesity, FA intake absent, maternal age >35 years, and maternal hypertension were found in 11 (16%), 5 (7.5%), 5 (7.5%), 4 (6%), and 2 (3%), respectively [Figure 2].
Figure 2: Distribution of maternal risk factors

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Consanguinity

Out of 67 children, 28 (41.79%) CHD children were born to consanguineously married couple [Figure 3].
Figure 3: Consanguinity

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Maternal stress

Maternal stress was present in 40% (n = 27) of the cases.

Presenting complaints

As shown in [Table 2], the most common presenting complaint was lower respiratory tract infection (LRTI), followed by shortness of breath (SOB). Three cases (4%) were asymptomatic in which only murmur was present clinically. Murmur, an impressive presentation of CHD, was seen in 70% (n = 47) of the cases. Majority of the cases (n = 56; 84%) were acyanotic type and cyanosis was present in 16% (n = 11) of the cases.
Table 2: Presenting complaints

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Acyanotic heart disease (n = 56)

Distribution of various types of acyanotic heart diseases is shown in [Table 3]. Atrial septal defect (ASD) was the most common which constituted 44.6%.
Table 3: Distribution of acyanotic heart diseases

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Cyanotic heart disease (n = 11)

Distribution of various types of cyanotic disease is shown in [Table 4]. Tetralogy of Fallot (TOF) was the most common with 18.1%.
Table 4: Distribution of cyanotic heart diseases

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Correlation between congenital heart diseases and maternal risk factors

In both cyanotic and acyanotic CHD groups, majority of the cases had no maternal risk factors (45.5% and 62.5%, respectively) [Table 5].
Table 5: Correlation between congenital heart disease and maternal risk factors

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Treatment patterns

Medical management with follow-up (52%) was advised in most of the cases followed by surgical (28%) and interventional (19%) procedures [Figure 4].
Figure 4: Treatment patterns advised

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  Discussion Top


The present study was conducted on 100 children who attended to the outpatient department of Cardiology, to know the spectrum of CHDs, Clinical Presentations, definitive diagnosis by Echocardiography, and their association with maternal risk factors. In this study, 30% of the children were diagnosed by the age of 1–5 years. In another Indian study, 82.6% children were diagnosed between the age group of 0–3 years.[13] The main reasons for delayed diagnosis of CHDs are probably related to the lack of diagnostic facilities, parental unawareness, social taboos, and financial constraints. In our study, male children were 57% while female children were 47%. This finding is similar to the observations of previously published studies.[14],[15],[16] Higher prevalence of male CHD cases may be related to gender bias.

LRTI was the major presenting symptom in our study. Consanguinity plays a major role in the incidence of major congenital malformation in children. In a study done by Kulkarni and Kurian, in 3700 consecutive births on the effect of consanguinity on fetal growth and development, 26% of the total births were to the consanguineously married couple. The incidence of congenital malformation was 39.1 per 1000 births with significantly higher incidence among the consanguineous group (8.01%) as against the nonconsanguineous group (2.42%). Malformation of cardiovascular system was 10 times more in the consanguineous group as compared to nonconsanguineous group.[17] In the present study, 28 children (41.79%) were born to consanguineously married couple.

In the present study, 47 children (70%) had murmur and remaining children presented without murmur. In a study conducted in Indore, 2603 newborns were screened for the presence of a murmur and murmur was detected in 62 babies (2.3%) of whom 8 (45%) had a cardiac malformation.[18] Hence, children having murmur should be carefully evaluated for underlying cardiac lesion and prompt early referral for an echocardiography and color Doppler examination as identification and treatment of heart disease before development of symptom offers the prospect of an improved outcome.

In the present study, 16% of the children belongs to cyanotic CHD group had TOF which is in agreement with the study findings reported by Shah et al.[15] In Acyanotic CHD, ASD was the most common, followed by VSD but in most of the studies VSD was reported as most common.

In our study, consanguinity, maternal diabetes mellitus, maternal age ≥35 years, and obesity were the risk factors among mothers of affected babies and may have contributed to the high prevalence of CHD in our population which is similar to the study done in Saudi.[19]

Limitations

This is a single-center study, and the sample size is relatively small.


  Conclusion Top


ASD and TOF were the most common types of CHD in acyanotic and cyanotic CHD groups, respectively. Consanguinity, stress during pregnancy, and diabetes mellitus were identified as major risk factors for CHD. LRTI and SOB were the most common clinical features in children with CHD.

Acknowledgment

We would like to thank Dr. B. Manohar, Professor, department of Pediatrics, Sri Venkateswara Medical College, SVRR Govt General Hospital, Tirupati for sending the suspected cases to our center for confirmation of congenital heart diseases.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Friedman WF, Silwerman N. Congenital heart disease in infancy and childhood. Braunwald Heart Disease. A Textbook of Cardiovascular Medicine. 6th ed. Philadelphia: Saunders; 2001. p. 1505.  Back to cited text no. 1
    
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Saxena A. Congenital heart disease in India: A status report. Indian J Pediatr 2005;72:595-8.  Back to cited text no. 2
    
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Hoffman JI. Congenital heart disease: Incidence and inheritance. Pediatr Clin North Am 1990;37:25-43.  Back to cited text no. 3
    
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Perloff JK. The Clinical Recognition of Congenital Heart Disease. 4th ed. Philadelphia: Saunders; 1998. p. 1-3.  Back to cited text no. 4
    
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Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39:1890-900.  Back to cited text no. 5
    
6.
Wechsler SB, Wernovsky G. Cardiac disorders. In: Cloherty JP, Eichenwald EC, Stark AR, editors. Manual of Neonatal Care. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2004. p. 407.  Back to cited text no. 6
    
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Chadha SL, Singh N, Shukla DK. Epidemiological study of congenital heart disease. Indian J Pediatr 2001;68:507-10.  Back to cited text no. 7
    
8.
Working Group on Management of Congenital Heart Diseases in India. Consensus on timing of intervention for common congenital heart disease. Indian Pediatr 2008;45:117-26.  Back to cited text no. 8
    
9.
Sharma S. Approach to a child with acyanotic heart disease. In: Kulkarni ML, editor. Pediatric Cardiology. 2nd ed. New Delhi: Jaypee Brothers Medical Publishers; 2003. p. 86-90.  Back to cited text no. 9
    
10.
Bernstein D. Congenital heart disease. In: Kliegman RM, BehrmanRE, Jenson HB, Stanton BF, editors. Nelson Textbook of Pediatrics. 18th ed. Philadelphia: Saunders; 2007. p. 1878-81.  Back to cited text no. 10
    
11.
Vaidyanathan B, Kumar RK. The global burden of congenital heart disease. Congenital Cardiol Today 2005;3:1-3.  Back to cited text no. 11
    
12.
Zeltser I, Tabutt S. Critical heart disease in newborn. In: Bell LM, Vetter VL, editors. Pediatric Cardiology – The Requisites in Pediatrics. Philadelphia: Elseiver; 2006. p. 31-3.  Back to cited text no. 12
    
13.
Kapoor R, Gupta S. Prevalence of congenital heart disease, Kanpur, India. Indian Pediatr 2008;45:309-11.  Back to cited text no. 13
    
14.
Vaidyanathan B, Sathish G, Mohanan ST, Sundaram KR, Warrier KK, Kumar RK. Clinical screening for congenital heart disease at birth: A prospective study in a community hospital in Kerala. Indian Pediatr 2011;48:25-30.  Back to cited text no. 14
    
15.
Shah GS, Singh MK, Pandey TR, Kalakheti BK, Bhandari GP. Incidence of congenital heart disease in tertiary care hospital. Kathmandu Univ Med J 2008;6:33-6.  Back to cited text no. 15
    
16.
Kasturi L, Kulkarni AV, Amin A, Mashankar VA. Congenital heart disease: Clinical spectrum. Indian Pediatr 1999;36:953.  Back to cited text no. 16
    
17.
Kulkarni ML, Kurian M. Consanguinity and its effect on fetal growth and development: A south Indian study. J Med Genet 1990;27:348-52.  Back to cited text no. 17
    
18.
Bansal M, Jain H. Cardiac murmur in neonates. Indian Pediatr 2005;42:397-8.  Back to cited text no. 18
    
19.
Majeed-Saidan MA, Atiyah M, Ammari AN, AlHashem AM, Rakaf MS, Shoukri MM, et al. Patterns, prevalence, risk factors, and survival of newborns with congenital heart defects in a Saudi population: A three-year, cohort case-control study. J Congenit Heart Dis2019;3:2.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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