Congenital Heart Disease

IJCS

Editorial

Epidemiological Profile: An Important Step in the Organization of Medical Care

The demographic-epidemiological study of a disease allows for a more accurate characterization of situations involving the care of this pathology and a better distribution of resources, often scarce, thereby optimizing patient care. In a scenario of general lack of financial, technological, and professional resources, it is necessary to develop a program that addresses all processes, streamlining the care network flow and,m consequently, that produces a positive impact on the outcome. Continuous reassessment of methods and criteria are necessary in order to evaluate the need for the reorganization and redirection of resources.

When treating congenital heart disease (CHD), the estimated prevalence may seem insignificant, when compared to other more prevalent cardiac pathologies, such as coronary artery disease. In Brazil, a prevalence of 12:1,000 live births with CHD has been estimated, corresponding to 25,757 new cases per year. These were responsible for 6% of all deaths in children < 1 year of age, according to data from Pinto Jr., Salim et al., observed that the main cause of death in young people under 20 years of age between 2000 and 2015 was circulatory system malformation. The clinical presentation of diseases is extremely variable, with symptoms that can start from the fetal period to adulthood and the correct diagnosis at an appropriate time is a determining factor for better therapeutic management and success. Lopes et al. demonstrated a lethality of 64.7% for critical CHD, which proved to be higher during the neonatal period. However, data on mortality must be interpreted in the context of available medical care in the studied region.

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IJCS

Original Article

Associated Factors with Congenital Heart Disease in the Most Populated State of Brazil Between 2010 and 2018

Isabela Madruga et al. Tatiane Dunder de Moraes Caroline Prado Carlos Eduardo Slateff Baldini Alfésio Luís Ferreira Braga

Abstract

Background

Cardiac anomalies are the most prevalent congenital malformations among live births in the world. In Brazil, it is estimated that nearly 25,757 new cases occur each year, and the Southeast region presents the highest prevalence, with 10 new cases/1,000 live births.

Objective

The aim of this study is to evaluate the epidemiology of congenital heart disease (CHD) in the state of São Paulo.

Methods

This is a cross-sectional and time-series observational study with data from the Brazilian Information System on Live Births. Heart-related cardiac malformation cases — International Classification of Diseases (ICD) 10th revision Q20.0 to Q24.9 — were selected from January 2010 to December 2018, in the state of São Paulo, Brazil. This study analyzed rates of malformations per year and investigated associated factors, using single and multiple logistic regression models. The significance level adopted in this study was 5%.

Results

The highest cardiac malformation rate was in the São Paulo metropolitan region (2.84:1000), while the lowest was found in the region of Franca (0.3:1000). The most frequent defect was interatrial communication (38.2%). The main associated factors observed in this study were prematurity of 22 to 27 weeks (OR=4,401 95% CI: 3,796-5,104) — CI: Confidence Interval; OR: Odds ratio —, mother’s age between 35 and 49 years of age (OR=1,602 95% CI: 1,525-1,682), yellow race (OR=1,481 95% CI: 1,235-1,775), triple or more pregnancy (OR=1,438 95% CI: 1,004-2,060), and history of a dead child (OR=1,213 95% CI: 1,152-1,277).

Conclusion

The main factors associated with this outcome, which are part of the obstetric history of mothers, should be addressed and considered when pregnancy is a planned event.

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ABC

Original Article

Epidemiological study of congenital heart defects in children and adolescents: analysis of 4,538 cases

Nelson Itiro Miyague et al. Silvia Meyer Cardoso Fabrício Meyer Frederico Thomaz Ultramari … Fábio Henrique Araújo Igor Rozkowisk Alisson Parrilha Toschi

OBJECTIVE: To analyze the frequency and prevalence of congenital heart defects in a tertiary care center for children with heart diseases. METHODS: We carried out an epidemiological assessment of the first medical visit of 4,538 children in a pediatric hospital from January 1995 to December 1997. All patients with congenital heart defects had their diagnoses confirmed at least on echocardiography. The frequency and prevalence of the anomalies were computed according to the classification of sequential analysis. Age, weight, and sex were compared between the groups of healthy individuals and those with congenital heart defects after distribution according to the age group. RESULTS: Of all the children assessed, 2,017 (44.4%) were diagnosed with congenital heart disease, 201 (4.4%) with acquired heart disease, 52 (1.2%) with arrhythmias, and 2,268 (50%) were healthy children. Congenital heart diseases predominated in neonates and infants, corresponding to 71.5% of the cases. Weight and age were significantly lower in children with congenital heart defects. Ventricular septal defect was the most frequent acyanotic anomaly, and tetralogy of Fallot was the most frequent cyanotic anomaly. CONCLUSION: Children with congenital heart defects are mainly referred during the neonatal period and infancy with impairment in gaining weight. Ventricular septal defect is the most frequent heart defect.

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Original Article

Right ventricular diastolic dysfunction in the postoperative period of tetralogy of Fallot

Silvia Meyer Cardoso et al. Nelson Itiro Miyague

OBJECTIVE: To assess right ventricular diastolic function in the intermediate postoperative period of repair of tetralogy of Fallot. METHODS: We carried out a case-control study with 60 patients divided into 2 groups as follows: 1) group I – 30 patients who had undergone repair of tetralogy of Fallot and 2) group II – 30 healthy children. The 2 groups were paired for age, sex, and body surface. The flows in the pulmonary and tricuspid valves were analyzed with Doppler echocardiography. The presence of anterograde flow at the end of diastole in the pulmonary artery defined restrictive right ventricular physiology. Surgical, radiological, electrocardiographic, and echocardiographic variables were analized in the group I. RESULTS: The velocity of the A wave and the E/A ratio for the tricuspid valve showed significant differences between the groups. Cases with E/A < 1.30 predominated in inspiration (group I – 19/30, and group II – 5/30). The duration of the QRS complex on the electrocardiogram was significantly increased in patients with E/A <1.30. Nineteen (63.3%) patients had restrictive right ventricular physiology, which had a longer postoperative period, longer duration of the QRS complex, and a lower E/A ratio in inspiration. The surgical and radiological variables showed no statistical difference. CONCLUSION: Restrictive right ventricular physiology was detected on the intermediate follow-up of most patients undergoing repair of tetralogy of Fallot. The postoperative period and QRS duration were increased in patients with impairment in diastolic function.

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Epidemiological Profile: An Important Step in the Organization of Medical Care

Associated Factors with Congenital Heart Disease in the Most Populated State of Brazil Between 2010 and 2018

Abstract

Background

Objective

Methods

Results

Conclusion

Epidemiological study of congenital heart defects in children and adolescents: analysis of 4,538 cases

Right ventricular diastolic dysfunction in the postoperative period of tetralogy of Fallot

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Formato de Documento Eletrônico (ABNT)

Formato de Documento Eletrônico (APA)

Formato de Documento Eletrônico (ISO)

Formato de Documento Eletrônico (Vancouver)

Formato de Documento Eletrônico (ABNT)

Formato de Documento Eletrônico (APA)

Formato de Documento Eletrônico (ISO)