Clinical Research Article
Mukul Misra et al
 

Prevalence and Pattern of Congenital Heart Disease in School Children of
Eastern Uttar Pradesh.
Mukul Misra, Mahim Mittal, A. M. Verma, Rajendra Rai, Gyan Chandra, D. P. Singh, Rahul Chauhan,
Vijay Chowdhary, R. P. Singh, A. K. Mall, Mohd. J. Khan, Suyash Khare, K. B. Yadav, Rajendra Kumar,
A. R. Aeron, Pramod K. Verma

Department of Medicine, BRD Medical College, Gorakhpur, India

Background and Aim: The prevalence of congenital heart disease (CHD) is not known in our country. The aim of present study was to find out the prevalence of CHD in school children of eastern Uttar Pradesh.

Method: A team consisting of a cardiologist, physicians and junior residents visited schools in the area. All the children were examined for presence of cardiac murmur or history of heart disease or any intervention. Those with murmurs or previous history of heart disease were called to the Medical College Hospital for evaluation by ECG, chest X-ray and echocardiography for confirmation of the lesion.

Results: Out of 118,212 children examined, 142 were found to have CHD. The prevalence was 1.3 per 1000 children and the commonest lesions were ventricular and atrial septal defects, aortic stenosis with or without regurgitation, and pulmonary stenosis.

Conclusion: CHD prevalence is 1.3 per 1000 school children that is nearly two and a half times more than that of RHD. Knowing it is important for development of facilities for CHD care in our setup.

Keywords: Congential heart disease, Venticular Septal Defects, Atrial Septal Defects, Aortic Stenosis, Aortic regurgitation, Pulmunory Stenosis.

INTRODUCTION

There are several reports of prevalence of rheumatic heart disease (RHD) that have been published from our country in past 25 years1. It is heartening to note that there is a decline in the prevalence of RHD in our country according to the latest survey reports1,2, although it remains 25 to 50 times higher than in Western Europe and United States3. However, we do not have any data on prevalence and pattern of congenital heart disease (CHD). Further more it has not drawn as much attention in our country as have RHD and coronary artery disease. The present study reports prevalence and pattern of CHD in eastern Uttar Pradesh of North India. Accurate assessment of prevalence of CHD in a society is needed since it is critical in understanding the demands placed on the health care system and the social and economic burdens placed on the patients and their families.

METHODS

The study was conducted by the Department of Medicine, BRD Medical College, Gorakhpur with help of local politicians and volunteers.

A team of examiners was constituted which included an experienced cardiologist (MM), 4 senior physicians, and 4 junior residents in medicine in rotation. The team visited various schools located in and around Gorakhpur (urban and semi-urban). All children between the ages of 4 to 18 years were examined within a period of 2½ years from July 2003 to January 2006. Of all the children examined, those with cardiac murmurs or history of treatment for heart disease (medical or surgical) were identified for further evaluation. They were then re-examined by the cardiologist on site. Those with suspected cardiac lesions were called to Medical College Hospital for ECG, chest radiography and color Doppler echocardiographic examination for confirmation of the diagnosis.

RESULTS

In a total of 1,18,212 (68,357 males, 49,855 females) children examined, 142 were identified as having congenital heart defects, thus giving a prevalence of 1.3 per 1000. The prevalence of RHD has been reported previously in an earlier communication1. The pattern of various CHDs observed is

Correspondence:Prof. Mukul Misra, Professor & Head, Department of Medicine, BRD Medical College, Gorakhpur - 273013
E-mail: mukul_rk_misra@indiatimes.com

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Indian Heart J. 2009; 61:58-60
 
Prevalence and Pattern of CHD in UP
 
 


Abbreviations:
AR-aortic regurgitation, AS-aortic stenosis, ASD-atrial septal defect, CHB-complete heart block, C-TGA-corrected transposition of great arteries, DORV-double outlet right ventricle, HCM-hypertrophic cardiomyopathy, PDA-patent ductus arteriosus, PS-pulmonary stenosis, SSS-sick sinus syndrome, VSD-ventricular septal defect.

The common CHDs identified were ventricular septal defect (VSD, n=58) followed by atrial septal defect (ASD, n=26). Amongst the valvular defects, aortic stenosis (AS, n=24) was seen twice more commonly than pulmonary stenosis (PS, n=12). Other defects were seen rarely. No child with congenital cyanotic heart defect was identified.

Out of 142 children, 11 (7.7%) had undergone surgery or intervention (balloon dilatation). One child with an ASD underwent surgery after diagnosis and motivation. Only 34 out of the remaining 131 children were aware of their defects.

DISCUSSION

Most of the surveys done in the past 10 to 20 years in the United States have identified birth prevalence of CHDs of 4 to 12 children per 1000 live births, and a rate of 10 per 1000 (or 1% of all live births) is often cited4. Other studies have reported birth prevalence ranging from 8.3 to 10.4 per 1000 live births5-9. The incidence from other countries is remarkably similar to that reported from the United States (Table 2)10-17.

The rates of occurrence of CHD in different reports vary because prevalence varies due to duration and intensity of case finding and the sensitivity of the diagnostic method used. The use of 2-D echocardiography has helped in diagnosing even very small defects and prevalence rates have increased as diagnosis has been enhanced. However, we do not know much about the prevalence of CHD in school

Table 2. Congenital heart disease in defined live-birth population
 

children i.e. between the ages of 5 to 15 years. This is an important population group and constitutes nearly 1/4th (23.6%) of the total population of our country according to the latest census report (2001) that poses major burden on our limited healthcare resources18. According to one estimate from our country nearly 50,000 children with CHD require surgery or some form of intervention in childhood19. Although there have been attempts to quantify the burden of CHD in India in the past, they fail to reflect the true prevalence19.

The present survey is an attempt to find the prevalence of CHD in school children of eastern Uttar Pradesh using ECG, chest radiography and 2-D echocardiography for confirmation of the diagnosis. The prevalence of CHD observed in our study is 1.3 per 1000 school children that is more than two and a half times than that of RHD (0.5 per 1000). As expected, the commonest defect seen was VSD followed by ASD. The 6 defects viz. VSD, ASD, AS, PS, patent ductus arteriosus and VSD with PS accounted for more than 90% of the lesions identified. This pattern corresponds with the pattern of CHD identified at birth (Table 3) 8,9.

 
Table 3. Incidence of specific congenital heart defects
 

aTotal number of cases=103,590
bIncludes tetralogy of Fallot
cIncludes partial and complete
The most important fact that emerges from our study is lack of awareness; only 11 out of 142 children had undergone surgery or interventional procedure, one child underwent closure of ASD after identification of the defect and

Indian Heart J. 2009; 61:58-60
 
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motivation, and only 34 out of the remaining 131(26%) were aware of their defects. It may be due to the fact that that most of the defects were mild and not causing any symptoms and in the absence of routine medical examination, remained unidentified. The value and need of proper routine medical examination before entry in schools, therefore, needs to be emphasized. We did not identify any children with cyanotic CHD in this survey; possibly because such children are too sick to attend schools and are therefore school dropouts. This highlights the pitfall in finding true prevalence of CHD by school children based surveys, and the need and importance of population based surveys for identifying true prevalence.

As such, we do not know any identifiable causes of CHD in most of the affected children. Prevention therefore, appears a far-fetched possibility. The best that can be offered is early identification and management of the problem. This may be achieved only by awareness and early examination and investigations. Many affected children may achieve cure or long-term palliation by this approach. Knowledge of prevalence of CHD is important because it can assist in co-ordination of pediatric cardiology services as well as advanced diagnostic and treatment facilities within a region.

CONCLUSIONS

Prevalence of CHD in school children of eastern Uttar Pradesh is 1.3 per 1000 and is more than that of RHD. Prevention is not possible in absence of known causes for the problem. Early identification and management appear the key to the solution of the problem. Proper medical examination of children taking admission to schools may be helpful in this regard. Only community based surveys can provide the exact estimate of the burden.

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