|ORIGINAL RESEARCH ARTICLE
|Year : 2020 | Volume
| Issue : 3 | Page : 105-109
Spectrum of congenital heart diseases and its correlation with maternal risk factors
Chandana Vakkala, Shifa Khanam Mohammad Patan, Latheef Kasala, Velam Vanajakshamma, Rajasekhar Durgaprasad
Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
|Date of Submission||07-Dec-2020|
|Date of Decision||25-May-2021|
|Date of Acceptance||31-May-2021|
|Date of Web Publication||30-Jun-2021|
Dr. Velam Vanajakshamma
Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati - 517 507, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
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|| |
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.,, 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.
The incidence of moderate-to-severe structural CHD in live born infants is 6–8 per 1000 live births.,, [7, This incidence has been relatively constant over the years and in the different parts of the world. 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.
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. Most congenital defects are well tolerated in the fetus because of the parallel nature of the fetal circulation.
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. 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.
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|| |
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 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|| |
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].
Out of 67 children, 28 (41.79%) CHD children were born to consanguineously married couple [Figure 3].
Maternal stress was present in 40% (n = 27) of the cases.
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.
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%.
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%.
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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Medical management with follow-up (52%) was advised in most of the cases followed by surgical (28%) and interventional (19%) procedures [Figure 4].
| Discussion|| |
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. 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.,, 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. 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. 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. 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.
This is a single-center study, and the sample size is relatively small.
| Conclusion|| |
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.
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
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]