Hostname: page-component-848d4c4894-x24gv Total loading time: 0 Render date: 2024-06-11T05:17:00.139Z Has data issue: false hasContentIssue false
  • English
  • Français

Prevalence of undiagnosed congenital cardiac defects in older children*

Published online by Cambridge University Press:  01 August 2008

Monesha Gupta-Malhotra ,
Archana Dave ,
Brian C. Sturhan ,
Karen McNiece ,
P. Syamasundar Rao  and
Ronald Portman
Monesha Gupta-Malhotra*
Affiliation:
Division of Pediatric Cardiology, Children’s Memorial Hermann Hospital, University of Texas Health Science Center at Houston, Houston, Texas, United States of America Division of Pediatric Nephrology, Children’s Memorial Hermann Hospital, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
Archana Dave
Affiliation:
Division of Pediatric Cardiology, Children’s Memorial Hermann Hospital, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
Brian C. Sturhan
Affiliation:
Division of Pediatric Nephrology, Children’s Memorial Hermann Hospital, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
Karen McNiece
Affiliation:
Division of Pediatric Nephrology, Children’s Memorial Hermann Hospital, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
P. Syamasundar Rao
Affiliation:
Division of Pediatric Cardiology, Children’s Memorial Hermann Hospital, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
Ronald Portman
Affiliation:
Division of Pediatric Nephrology, Children’s Memorial Hermann Hospital, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
*
Correspondence to: Monesha Gupta, MBBS, Division of Pediatric Cardiology, Co-Director, Fetal Echocardiography, Clinical Director, Pediatric Hypertension, Children’s Memorial Hermann Hospital, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 3130, Houston, Texas 77030, USA. Tel: +713 500 5743; Fax: +713 500 5751; E-mail: monesha.gupta@uth.tmc.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Certain congenital cardiac defects may go undetected for several years due to lack of symptoms and signs. Our purpose was to determine the prevalence of such defects among children greater than one year of age.

Methods

The study was performed on subjects diagnosed with systemic hypertension, aged from 1 to 19 years, with a mean of 12.4 years, in whom we performed echocardiography, using a standard protocol, to establish any end-organ damage or to reveal any congenital cardiac defects.

Results

We found a congenital cardiac defect in 5 (3.5%) of the 143 children evaluated. Of these, 4 had not previously been detected, specifically Ebsteins malformation of the tricuspid valve, with moderate regurgitation, a coronary arterial anomaly, a bicuspid aortic valve, and prolapse of the mitral valve permitting regurgitation. In the other patient, we found a non-significant tiny muscular ventricular septal defect.

Conclusions

Our transthoracic echocardiographic investigation revealed previously unsuspected congenital cardiac defects in 4 of 143 older children, with 3 of these requiring further management by a paediatric cardiologist. A similar prevalence has also been reported in older children evaluated echocardiographically for other diseases such as insulin-resistance and leukemia. Hence, it is possible that the prevalence of congenitally malformed hearts is higher than previously reported. When clinically indicated, clinicians should more readily consider obtaining an echocardiogram to help in the identification of such malformations.

Keywords

Ebstein’s malformationbicuspid aortic valvemitral valvar prolapse
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue 4 , August 2008 , pp. 392 - 396
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

The presentation on which this work is based was given at the Inaugural Meeting of the World Society for Pediatric and Congenital Heart Surgery, held in Washington, District of Columbia, May 3 and 4, 2007.

References

1.Ferencz, C, Rubin, JD, McCarter, RJ, et al. Congenital heart disease: prevalence at livebirth. The Baltimore-Washington Infant Study. Am J Epidemiol 1985; 121: 31–36.CrossRefGoogle ScholarPubMed
2.Laursen, HB. Some epidemiological aspects of congenital heart disease in Denmark. Acta Paediatr Scand 1980; 69: 619–624.CrossRefGoogle ScholarPubMed
3.Hoffman, JI, Christianson, R. Congenital heart disease in a cohort of 19,502 births with long-term follow-up. Am J Cardiol 1978; 42: 641–647.CrossRefGoogle Scholar
4.Feldt, RH, Avasthey, P, Yoshimasu, F, Kurland, LT, Titus, JL. Incidence of congenital heart disease in children born to residents of Olmsted County, Minnesota, 1950–1969. Mayo Clin Proc 1971; 46: 794–799.Google ScholarPubMed
5.Carlgren, LE. The incidence of congenital heart disease in children born in Gothenburg 1941–1950. Br Heart J 1959; 21: 40–50.CrossRefGoogle ScholarPubMed
6.Bound, JP, Logan, WF. Incidence of congenital heart disease in Blackpool 1957–1971. Br Heart J 1977; 39: 445–450.CrossRefGoogle ScholarPubMed
7.Fixler, DE, Pastor, P, Chamberlin, M, Sigman, E, Eifler, CW. Trends in congenital heart disease in Dallas County births. 1971–1984. Circulation 1990; 81: 137–142.CrossRefGoogle ScholarPubMed
8.Dickinson, DF, Arnold, R, Wilkinson, JL. Congenital heart disease among 160 480 liveborn children in Liverpool 1960 to 1969. Implications for surgical treatment. Br Heart J 1981; 46: 55–62.CrossRefGoogle ScholarPubMed
9.Roy, DL, McIntyre, L, Human, DG, et al. Trends in the prevalence of congenital heart disease: comprehensive observations over a 24-year period in a defined region of Canada. Can J Cardiol 1994; 10: 821–826.Google Scholar
10.Samanek, M, Voriskova, M. Congenital heart disease among 815,569 children born between 1980 and 1990 and their 15-year survival: a prospective Bohemia survival study. Pediatr Cardiol 1999; 20: 411–417.CrossRefGoogle ScholarPubMed
11.Roguin, N, Du, ZD, Barak, M, Nasser, N, Hershskowitz, S, Milgram, E. High prevalence of muscular ventricular septal defect in neonates. J Am Coll Cardiol 1995; 26: 1545–1548.CrossRefGoogle ScholarPubMed
12.Hoffman, JI. Incidence of congenital heart disease: I. Postnatal incidence. Pediatr Cardiol 1995; 16: 103–113.CrossRefGoogle ScholarPubMed
13.Muta, H, Akagi, T, Egami, K, et al. Incidence and clinical features of asymptomatic atrial septal defect in school children diagnosed by heart disease screening. Circ J 2003; 67: 112–115.CrossRefGoogle ScholarPubMed
14.Ayabakan, C, Ozkutlu, S, Kilic, A. The Doppler echocardiographic assessment of valvular regurgitation in normal children. Turk J Pediatr 2003; 45: 102–107.Google ScholarPubMed
15.Sekhobo, JP, Druschel, CM. An evaluation of congenital malformations surveillance in New York State: an application of Centers for Disease Control and Prevention (CDC) guidelines for evaluating surveillance systems. Public Health Rep 2001; 116: 296–305.CrossRefGoogle ScholarPubMed
16.Abu-Harb, M, Hey, E, Wren, C. Death in infancy from unrecognised congenital heart disease. Arch Dis Child 1994; 71: 3–7.CrossRefGoogle ScholarPubMed
17.Abu-Harb, M, Wyllie, J, Hey, E, Richmond, S, Wren, C. Antenatal diagnosis of congenital heart disease and Down’s syndrome: the potential effect on the practice of paediatric cardiology. Br Heart J 1995; 74: 192–198.CrossRefGoogle ScholarPubMed
18.Kuehl, KS, Loffredo, CA, Ferencz, C. Failure to diagnose congenital heart disease in infancy. Pediatrics 1999; 103(4 Pt 1): 743–747.CrossRefGoogle ScholarPubMed
19.Steinberger, J, Moller, JH, Berry, JM, Sinaiko, AR. Echocardiographic diagnosis of heart disease in apparently healthy adolescents. Pediatrics 2000; 105(4 Pt 1): 815–818.CrossRefGoogle ScholarPubMed
20.Hoffman, JI, Kaplan, S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 1890–1900.CrossRefGoogle ScholarPubMed
21.Hoffman, JI. Incidence of congenital heart disease: II. Prenatal incidence. Pediatr Cardiol 1995; 16: 155–165.CrossRefGoogle ScholarPubMed
22.George, RE, Lipshultz, SE, Lipsitz, SR, Colan, SD, Diller, L. Association between congenital cardiovascular malformations and neuroblastoma. J Pediatr 2004; 144: 444–448.CrossRefGoogle ScholarPubMed
23.Smythe, JF, Teixeira, OH, Vlad, P, Demers, PP, Feldman, W. Initial evaluation of heart murmurs: are laboratory tests necessary? Pediatrics 1990; 86: 497–500.CrossRefGoogle ScholarPubMed
24.Klewer, SE, Samson, RA, Donnerstein, RL, Lax, D, Zamora, R, Goldberg, SJ. Comparison of accuracy of diagnosis of congenital heart disease by history and physical examination versus echocardiography. Am J Cardiol 2002; 89: 1329–1331.CrossRefGoogle ScholarPubMed
25.Danford, DA, Martin, AB, Fletcher, SE, Gumbiner, CH. Echocardiographic yield in children when innocent murmur seems likely but doubts linger. Pediatr Cardiol 2002; 23: 410–414.CrossRefGoogle ScholarPubMed
26.Lamas, CC, Eykyn, SJ. Bicuspid aortic valve – A silent danger: analysis of 50 cases of infective endocarditis. Clin Infect Dis 2000; 30: 336–341.CrossRefGoogle ScholarPubMed
27.Gaudio, C, Tanzilli, G, Ferri, FM, Pannarale, G, Collauto, F. Therapeutic assessment of adult patients with isolated corrected transposition of the great arteries. G Ital Cardiol 1998; 28: 714–717.Google ScholarPubMed
28.Borjesson, M, Dellborg, M, Nylander, E. Sudden cardiac death (SCD) associated with sports in young individuals. Scand J Med Sci Sports 2006; 16: 376–377.Google ScholarPubMed
29.Polderman, FN, Cohen, J, Blom, NA, et al. Sudden unexpected death in children with a previously diagnosed cardiovascular disorder. Int J Cardiol 2004; 95: 171–176.CrossRefGoogle ScholarPubMed
30.Gill, DS, Yong, QW, Wong, TW, Tan, LK, Ng, KS. Vegetation and bilateral congenital coronary artery fistulas. J Am Soc Echocardiogr 2005; 18: 492–493.CrossRefGoogle ScholarPubMed
31.Suzuki, Y, Daitoku, K, Minakawa, M, Fukui, K, Fukuda, I. Infective endocarditis with congenital heart disease. Jpn J Thorac Cardiovasc Surg 2006; 54: 297–300.CrossRefGoogle ScholarPubMed
32.Takeda, S, Nakanishi, T, Nakazawa, M. A 28-year trend of infective endocarditis associated with congenital heart diseases: a single institute experience. Pediatr Int 2005; 47: 392–396.CrossRefGoogle ScholarPubMed