Comorbidities with Congenital Heart Disease among Hospitalized Children in a Specialized Cardiac Hospital in Bangladesh

Background: Congenital heart diseases (CHD) when associated with any comorbid condition may complicate the outcome of management. So to find out and treat comorbidities before definite treatment is essential for better outcome. Methods: This observational cross sectional study was conducted in the inpatient Department of Paediatric Cardiology at National Institute of Cardiovascular Diseases, Dhaka, during the period of January 2014 to January 2015 to identify the comorbid conditions of congenital heart disease.Results: A total of 794 children with different types of congenital heart disease were enrolled during the study period. Among them, 48.6% were simple CHD and 51.4% were complex CHD. Among simple CHD, ventricular septal defect (VSD) was commonest (27.2%), Tetralogy of Fallot (TOF) occupied the second position (20.5%). One child presented with Ectopia cardis. Among complex CHD most common anomalies were VSD with either atrial septal defect (ASD) or patent ductus arteriosus (PDA) or valvular lesion. Next common anomalies were TOF with PDA or ASD &/or pulmonary valvular abnormalities. Double outlet of right ventricle (DORV) with shunt and transposition of great arteries (TGA) with shunt also occur frequently. AV canal defect with or without valvular lesion presented in significant number. Among them 616 (77.6%) had different types of comorbid conditions. Among comorbidities, respiratory and acquired cardiac comorbidities were common (37.9% & 34.1% respectively). Other congenital or genetic comorbidities were in 11.2%. Multisystem involvement was in 9.8% cases.Conclusion: Pneumonia and heart failure were the most frequent comorbid condition among both simple and complex congenital heart disease. They were common among acyanotic heart disease. But cyanotic spell, acute stroke syndrome and brain abscess were common among cyanotic heart disease. Among genetic comorbidities Downs syndrome occupied the major part.Cardiovasc. j. 2017; 9(2): 83-89

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Stenting of modified Blalock–Taussig shunt in adult with palliated pulmonary atresia and ventricular septal defect: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytz201 ◽

2019 ◽

Vol 3 (4) ◽

pp. 1-4

Author(s):

Julia Illner ◽

Holger Reinecke ◽

Helmut Baumgartner ◽

Gerrit Kaleschke

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Ventricular Septal Defect ◽

Pulmonary Artery ◽

Congenital Heart ◽

Septal Defect ◽

Pulmonary Atresia ◽

Complex Congenital Heart Disease ◽

Bare Metal

Abstract Background Adults with complex congenital heart disease palliated with systemic-to-pulmonary artery shunts have become rare and represent a particularly challenging patient group for the cardiologist. One of the complications and causes of severe clinical deterioration during long-term follow-up are progressive obstruction or total occlusion of the shunt. The risk for surgical intervention is frequently high and catheter intervention may be complicated by complex anatomy and shunt calcification. Case summary We report the case of a 47-year-old man with uncorrected (palliated) pulmonary atresia and ventricular septal defect who presented with progressive cyanosis (oxygen saturation 69%) and decreasing exercise capacity. Computed tomography revealed a totally occluded modified left Blalock–Taussig (BT) shunt and a severely stenosed central shunt (Waterston–Cooley) in a patient with confluent but hypoplastic pulmonary arteries and multiple major aortic pulmonary collaterals. Due to a high operative risk, an interventional, percutaneous approach was preferred to re-do surgery. From a radial access the calcified BT shunt could be crossed with a hydrophilic guidewire. Then, a rotational thrombectomy, balloon dilatation, and bare-metal stenting at the proximal and distal anastomoses were performed. Post-interventionally, peripheral oxygen saturation increased from 69% to 82%. Clopidogrel was administered for 1 month after bare-metal stenting. At 1-year follow-up, the BT shunt was still patent on echocardiography and exercise tolerance markedly improved. Discussion This case highlights the benefit of percutaneous rotational thrombectomy followed by stenting of chronically occluded systemic-to-pulmonary artery shunts for further palliation in adult patients with complex congenital heart disease not suitable for surgical repair.

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Atrial septal defects (ASDs)

10.1093/med/9780199228188.003.0013 ◽

2011 ◽

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Atrial Septal Defect ◽

Coronary Sinus ◽

Patent Foramen Ovale ◽

Congenital Heart ◽

Septal Defect ◽

Foramen Ovale ◽

Septal Defects ◽

Different Types

Introduction 94Ostium secundum ASD 96Ostium primum ASD 100Sinus venosus ASD 100Coronary sinus defect 102Patent foramen ovale 104Interatrial communications account for ~10% of congenital heart disease. Different types of atrial septal defect (ASD) are illustrated in Fig. 8.1.•...

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Acute ischaemic stroke in secondary polycythaemia due to complex congenital cyanotic heart disease

BMJ Case Reports ◽

10.1136/bcr-2019-231261 ◽

2019 ◽

Vol 12 (10) ◽

pp. e231261

Author(s):

Jeyaraj Durai Pandian ◽

Ivy Anne Sebastian ◽

Ashlee Sidhu

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Ischaemic Stroke ◽

Congenital Heart ◽

Septal Defect ◽

Brain Mri ◽

Neurological Deficits ◽

Complex Congenital Heart Disease ◽

Haematocrit Level ◽

Polycythaemia Vera

A 65-year-old woman presented to the emergency department with an acute onset of left-sided hemiparesis and slurred speech for 6 hours. Physical examination was notable for clubbing and peripheral cyanosis. Brain MRI showed an acute infarct involving the right gangliocapsular region. Investigations showed an elevated haemoglobin level, a haematocrit level of >65% and thrombocytopaenia. Transthoracic echocardiography revealed tricuspid atresia, ventricular septal defect and atrial septal defect. A diagnosis of cyanotic congenital heart disease was made. Studies have indicated an association between raised haematocrit and vascular occlusive episodes in patients with polycythaemia vera. However, a relationship between raised haematocrit due to polycythaemia secondary to complex congenital heart disease and vascular thrombosis has not been reported. The improvement of neurological deficits in our patient coincided with a decline in haematocrit. The objective of this report was to highlight an association between elevated haematocrit and ischaemic stroke in patients with secondary polycythaemia due to complex congenital heart disease.

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Cardiopatias Congénitas Complexas: Influência do Diagnóstico Pré-Natal

Acta Médica Portuguesa ◽

10.20344/amp.5753 ◽

2015 ◽

Vol 28 (2) ◽

pp. 158 ◽

Cited By ~ 1

Author(s):

Marta Correia ◽

Fabiana Fortunato ◽

Duarte Martins ◽

Ana Teixeira ◽

Graça Nogueira ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Prenatal Diagnosis ◽

Congenital Heart ◽

Pulmonary Atresia ◽

Complex Congenital Heart Disease ◽

Significant Relation ◽

Transposition Of Great Arteries ◽

Birth Place ◽

Tertiary Center

Introduction: Complex congenital heart disease is a group of severe conditions. Prenatal diagnosis has implications on morbidity and mortality for most severe conditions. The purpose of this work was to evaluate the influence of prenatal diagnosis and distance of residence and birth place to a reference center, on immediate morbidity and early mortality of complex congenital heart disease. Material and Methods:: Retrospective study of complex congenital heart disease patients of our Hospital, born between 2007 and 2012. Results:: There were 126 patients born with complex congenital heart disease. In 95%, pregnancy was followed since the first trimester, with prenatal diagnosis in 42%. There was a statistically significant relation between birth place and prenatal diagnosis. Transposition of great arteries was the most frequent complex congenital heart disease (45.2%), followed by pulmonary atresia with ventricular septal defect (17.5%) and hypoplastic left ventricle (9.5%). Eighty-two patients (65.1%) had prostaglandin infusion and 38 (30.2%)were ventilated before an intervention. Surgery took place in the neonatal period in 73%. Actuarial survival rate at 30 days, 12 and 24 months was 85%, 80% and 75%, respectively. There was no statistically significant relation between prenatal diagnosis and mortality. Discussion:: Most patients with complex congenital heart disease did not have prenatal diagnosis. All cases with prenatal diagnosis were born in a tertiary center. Prenatal diagnosis did not influence significantly neonatal mortality, as already described in other studies with heterogeneous complex heart disease. Conclusion:: prenatal diagnosis of complex congenital heart disease allowed an adequate referral. Most patients with complex congenital heart disease weren’t diagnosed prenatally. This data should be considered when planning prenatal diagnosis of congenital heart disease.

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Pre-operative coagulopathy management of a neonate with complex congenital heart disease: a case study

Perfusion ◽

10.1177/026765910001500212 ◽

2000 ◽

Vol 15 (2) ◽

pp. 161-168 ◽

Cited By ~ 8

Author(s):

Alfred H Stammers ◽

Eric D Rauch ◽

Lynne D Willett ◽

Jamie W Newberry ◽

Kim F Duncan

Keyword(s):

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

Congenital Heart ◽

Septal Defect ◽

Fresh Frozen Plasma ◽

Complex Congenital Heart Disease ◽

At Iii ◽

Fresh Frozen ◽

Frozen Plasma

Severe coagulation defects often develop in neonates undergoing cardiac surgery, both as a result of the surgical intervention, and as pre-existing defects in the hemostatic mechanisms. The following case report describes a newborn patient with complex congenital heart disease and respiratory failure whose pre-operative coagulopathy was aggressively managed prior to surgical correction. A 5-day-old, 2.5 kg child presented with interrupted aortic arch, ventricular septal defect, atrial septal defect, and patent ductus arteriosus. On admission, he was in respiratory arrest suffering from profound acidemia. In addition, the child was hypothermic (30.1°C), septic ( Streptococcus viridans), and coagulopathic (disseminated intravascular coagulation - DIC). The patient was immediately intubated and initial coagulation assessment revealed the following: prothrombin time (PT) 48.9 s (international normalized ratio (INR) 15.7), activated partial thromboplastin time (aPTT) •106 s, platelet count 30 000 mm3, fibrinogen 15 mg dL-1 and antithrombin III (AT-III) 10%. Before cardiac surgery could be performed, the patient’s DIC was corrected with the administration of cryoprecipitate (15 ml), fresh frozen plasma (300 ml), and platelets (195 ml). In spite of the large transfusion of fresh frozen plasma, the AT-III activity, measured as a percentage, remained depressed at 33. Initial thromboelastographic (TEG) determination revealed an index of +2.02, and following 100 IU administration of an AT-III concentrate, declined to -2.32. Sequential TEG profiles were performed over several days, with the results used to guide both transfusion and medical therapy. The congenital heart defect correction was subsequently performed with satisfactory initial results, but the patient developed a fungal infection and expired on the 16th post-operative day. The present case describes techniques of coagulation management for a newborn with both a severe hemostatic defect and congenital heart disease.

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Prevalence and Spectrum of Complex Congenital Heart Disease in the Neonatal Intensive Care Unit at high Altitude in China

10.21203/rs.3.rs-62194/v1 ◽

2020 ◽

Author(s):

Jing-Jing Li ◽

Xiao-Rong Wang ◽

Yuan Liu ◽

Guo-Dong Zhao ◽

Ting Dai ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Aortic Stenosis ◽

High Altitude ◽

Congenital Heart ◽

Septal Defect ◽

Severe Aortic Stenosis ◽

Pulmonary Stenosis ◽

Complex Congenital Heart Disease ◽

Anomalous Pulmonary Venous Connection

Abstract Background: Previous studies from high altitudes have reported significantly higher prevalence of congenital heart disease (CHD), consisting almost solely of simple CHD. Little is known about the occurrence of complex CHD. Neonates with complex CHD are likely admitted to NICU. We examined the prevalence and spectrum of complex CHD in NICU in order to depict a truer picture of CHD at high altitude.Methods: We reviewed charts of 4,214 neonates admitted to NICU in Qinghai province (average altitude 3,000m). Echocardiography was performed in 1,943 babies when CHD was suspected based on clinical examinations.Results: CHD was diagnosed in 1,093(56.3% of echoed babies). Mild CHD in 96.8%(1058 babies). Moderate CHD in 0.8%(9) included 1(0.1%) large secundum atrial septal defect, 3(0.3%) moderate pulmonary stenosis, 2(0.2%) aortic stenosis and 3(0.3%) partial anomalous pulmonary venous connection. Severe CHD in 2.4%(26) included 6(0.5%) complete atrioventricular septal defect, 5(0.5%) complete transposition of the great arteries, 5(0.5%) hypoplastic right heart, 3(0.3%) hypoplastic left heart, 3(0.3%) double outlet right ventricle, 3(0.3%) tetralogy of Fallot, 2(0.2%) truncus arteriosus, 2(0.2%) total anomalous pulmonary venous connection, 2(0.2%) severe aortic stenosis, 2(0.2%) Interrupted aortic arch and 2(0.2%) severe pulmonary stenosis and 1(0.1%) single-ventricle abnormality. At two-years follow-up in 737(67.4%) patients, 18(90%) with severe CHD and 38(5.3%) with mild and moderate CHD died, and 15 underwent cardiac surgery with 1 early death.Conclusions: At high altitude, a wide spectrum of CHD exists, with many heretofore unreported complex CHD. There is urgent need for routine echocardiography and early interventions in newborns particularly in NICU.

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Impact of COVID-19 in adult patients with congenital heart disease

European Heart Journal ◽

10.1093/eurheartj/ehab724.1848 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

I Cardoso ◽

T B Branco ◽

A Constante ◽

J Martins ◽

L Sousa ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Septal Defect ◽

Adult Patients ◽

Transposition Of Great Arteries ◽

Tertiary Centre ◽

Increased Risk ◽

Atrioventricular Canal Defect ◽

The Impact

Abstract Background COVID-19 is responsible for a worldwide pandemic, causing more than 13 000 deaths to date in Portugal. Data already exists regarding the increased risk of adverse events in patients with cardiovascular diseases, however the impact of SARS-CoV-2 infection in patients (P) with congenital heart disease (CHD) is still under investigation. Aims To evaluate the impact of COVID-19 in adult patients with congenital heart disease in our tertiary centre Methods Adult patients seen at the CHD outpatient's clinic at a tertiary centre, who became infected with SARS-CoV-2 infection up to February 2021 were included. Assessment of patients' symptoms, need for hospitalization and admission in an intensive care unit was assessed based on medical records. Results We identified 36 patients (pts) with COVID-19 infection. Symptoms were present in 31 (86%). The median age was 39 (32–49) years, 58% were females. Seven P (19%) had complex cyanotic disease; three (8%) Tetralogy of Fallot; three (8%) transposition of great arteries (one after Senning procedure and 2 after arterial switch); six (14%) right ventricle obstacle; two (8%) atrioventricular canal defect; four (11%) atrial septal defect; five (14%) ventricular septal defect; five (14%) aortic coarctation; two aortopathies (one submitted do David procedure); one subaortic stenosis; two (6%) had Eisenmenger syndrome. The majority (61%) of P had previous surgery and 58% were at New York Heart Association class of I. Mild symptoms were reported by 24 P (67%). Seven adults experienced moderate symptoms (dyspnea and hypoxia) that led to hospitalization for oxygen therapy, although none required mechanical ventilation. One death was reported. There was a significant association between the gravity of CHD and hospitalizations (p=0.012). Conclusion Our pts had mainly mild to moderate symptoms and did not appear to have a disproportionately negative outcome; the need for hospitalization was more frequent in patients with higher CHD gravity. These findings are in line with the emerging data regarding COVID-19 in CHD P, and may be in part explained by the patient's young age and functional status. FUNDunding Acknowledgement Type of funding sources: None.

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Isolated Interrupted Aortic Arch- A Complex Congenital heart disease

Cardiovascular Journal ◽

10.3329/cardio.v4i1.9400 ◽

1970 ◽

Vol 4 (1) ◽

pp. 102-104

Author(s):

A Shariar ◽

MA Huq ◽

NU Zakia ◽

M Salim ◽

SA Islam

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Aortic Arch ◽

Congenital Heart ◽

Septal Defect ◽

Interrupted Aortic Arch ◽

Cardiac Anomaly ◽

Complex Congenital Heart Disease ◽

Type B ◽

Left Carotid Artery

Interrupted Aortic Arch (lAA) is the absence or discontinuation of a portion of the aortic arch. There are three types of Interrupted Aortic Arch,and they are classified according to the site of the interruption. lsolated IAA appears commonly in type B lAA,where the interruption occurs between the left carotid artery and the left subclavian artery.In such case there is no associated cardiac anomaly and the patient may not exhibit lethal form of presentation unless there is duct dependent circulation or ventricular septal defect. lsolated interrupted arch is relatively rare congenital anomaly and very few cases were reported in literature so far. Keywords: lnterrupted aortic arch; Complex congenital heart disease. DOI: http://dx.doi.org/10.3329/cardio.v4i1.9400 Cardiovasc. J. 2011; 4(1): 102-104

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Frequency and types of congenital heart disease in neonates: A cross-sectional study from large public sector hospital of Karachi, Pakistan

Journal of Fatima Jinnah Medical University ◽

10.37018/jfjmu.661 ◽

2020 ◽

Vol 13 (4) ◽

pp. 163-165

Author(s):

Misbah Majeed ◽

Muhammad Ashfaq ◽

Bader U Nisa ◽

Aijaz Ahmed ◽

Jai Parkash

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Septal Defect ◽

Tertiary Care ◽

Cross Sectional Study ◽

Care Hospital ◽

Sectional Study ◽

Cross Sectional ◽

Transposition Of Great Arteries

Background: Congenital heart disease (CHD) is one of the frequent congenital health issues in neonates. Early diagnosis is a key factor to combat this problem. This study aims to assess the frequency and common types of CHD among neonates presenting to a tertiary care hospital, Karachi. Patients and methods: This descriptive cross-sectional study was conducted in a Neonatal Intensive Care Unit (NICU) of National Institute of Child Health (NICH), Karachi from March to September 2017. All neonates of gestational age ≥37 weeks with suspected CHD (presence of blue-tinged skin, i.e. cyanosis on routine clinical examination) were included. Information regarding presence of CHD and its types were collected along with the demographic characteristics and history of the patients. Results: Of 134, frequency of CHD was observed in 126 (94%) patients. Out of these 126 CHD patients, Ventricular septal defect (VSD) was observed in 49 (38.9%), patent ductal arteriosus (PDA) in 29 (23%), atrial septal defect (ASD) was observed in 19 (15.1%), Transposition of great arteries (TGA) in 18 (14.3%), and tetralogy of Fallot (TOF) in 14 (11.1%) patients. A significant association of VSD was observed with neonatal age (p = <0.001), ASD with neonatal age (p = 0.037) and maternal age (p = 0.025), while TGA was found significantly associated with neonatal age (p<0.001). Conclusion: CHD was observed in majority of the suspected patients with VSD as commonest type of congenital heart diseases among neonates.

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Prevalence of Congenital Heart Disease in Neonate in a Tertiary Level Hospital

Nepal Journal of Medical Sciences ◽

10.3126/njms.v2i2.8942 ◽

2013 ◽

Vol 2 (2) ◽

pp. 91-95 ◽

Cited By ~ 1

Author(s):

Md. Nazrul Islam ◽

MA Hossain ◽

MA Khaleque ◽

MK Das ◽

MRH Khan ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Cleft Lip ◽

Septal Defect ◽

Ductus Arteriosus ◽

College Hospital ◽

Cross Sectional ◽

Transposition Of Great Arteries ◽

Mortality And Morbidity

Background: Congenital heart disease (CHD) has already been recognized as one of the important cause of neonatal mortality and morbidity. The reported prevalence of CHD in live newborns tends to vary a lot due to various unrecognizable lesions at birth and lack of technical expertise. Methods: A cross sectional study was carried out in the department of Neonatology at Mymensingh Medical College Hospital (MMCH), Bangladesh from January to December 2010 to find prevalence of CHD in neonates. Results: Out of 6560 admitted neonates, 51 were found to have CHD. The prevalence was 7.8/1000 live births. Mean age was 10.2±9.8 days and weight was 2380.5±590.5gms. Respiratory distress was the commonest symptom (71%) followed by cyanosis (26%) and reluctant to feed (24%). Among the CHD Ventricular septal defect (VSD) was the commonest 15/51 and then Atrial septal defect (ASD) 12/51, Patent ductus arteriosus (PDA) 5/51, Transposition of great arteries ( TGA) 4/51, Complex heart disease 4/51 and Tetralogy of Fallot (TOF) 3/51 cases. Some associated non-cardiac anomalies like Down’s syndrome, polydactyly, syndactyly, cleft lip, cleft palate and cataract were found. Risk factors associated with CHD were diabetes mellitus (10%), hypertension (8%) and maternal infection (4%). Among the drugs, anti-pyretic by 20%, anti-emetic by 18%, anti-epileptic by 4%, vitamin-A and hormone each by 2% of mothers respectively. Conclusion: VSD and ASD were the commonest CHD in this study. Thorough clinical examination and proper investigations immediately after admission is essential, which may help us for proper counseling and early intervention. Nepal Journal of Medical Sciences | Volume 02 | Number 02 | July-December 2013 | Page 91-95 DOI: http://dx.doi.org/10.3126/njms.v2i2.8942

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