Spectrum of congenital heart diseases in Meghalaya –A Hospital

based studySourabh 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 ofcases seenduring studyperiod

Cases of CHD

Results- No. of referred cases

Thirty two percent(32%)cases were referred cases.

Pie diagram showing percentage of the referred cases

68%

32%

referred cases

not referred cases

Results- Distribution of cases during the study period

Distribution of cases during the study period

91(31.81)

69(24.12)

52(18.18)

46(16.08)

28(9.79)

0102030405060708090

100

Jan-June'05

July-Dec'05

Jan-June'06

July-Dec'06

Jan-June'07

Cases increased from 9.79% in Jan-June’05 to 31.81%

in Jan-June’07.

Results- age wise distribution

4.196.99

9.0910.48

26.92

13.28

1.39

4.89

0

5

10

15

20

25

301st

yr

2nd y

r

3rd

yr

4th

yr

5th

yr

6th

yr

7th

yr

8th

yr

9th

yr

10th

yr

11th

yr

12th

yr

13th

yr

14th

yr

15th

yr

16th

yr

17th

yr

18th

yr

Maximum cases were diagnosed during infancy(26.92%) followed by second year(13.28%) of life.

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

54%

46%Male

Female

The present study shows that, 131(46%) male and

155(54%) female children had CHD.

Results– sex wise distribution

63

29

13 13

73

38

24

3532

10

4 40

20

10

20

30

40

50

60

70

80

VSD ASD PDA TOF PS ECD AS others

Male

Female

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 studyPlace 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.

Analysis revealed a prevalence of CHD 2.32% which was not as high as other parts of the country.

2.32%2.50%

3%

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

Present study South India Punjab

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)

Comparison of the prevalence of major CHDs in different studies in

India.

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 Jan-

June’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.

ConclusionThe 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 youThank you