Letters

Letters to the Editor

Indian Pediatrics 1999;36: 953

Congenital Heart Disease: Clinical Spectrum

Congenital heart disease refers to structural or functional heart disease that is present at birth even if it is discovered much later. Congenital heart disease occurs in approximately 8/1000 live births. The present study was conducted to ascertain the pattern of Congenital heart disease in 108 subjects (newborn to 14 years old). Seventy per cent of them were diagnosed before the age of one year. Most of the cases, especially in the neonatal period were detected on routine examination.

Sixty three subjects (58%) were asympto-matic and 45 cases (42%) were symptomatic. Common signs and symptoms were difficulty in feeding, excessive sweating, cyanosis, tachycardia, tachypnea, intercostal retractions and congestive cardiac failure. Majority of the children who were symptomatic presented in the first year of life.

In this series, 90/108 (82%) belonged to acyanotic group, ventricular septal defect being the commonest lesion and 18/108 (19%) belonged to cyanotic group, tetralogy of Fallot's was the commonest cyanotic lesion. Table I gives the relative frequency of various lesions.

Sixty four of one hundred and eight patients underwent surgery. Surgery was required in all the cyanotic patients (18/108). Among them four patients died before surgery. In the acyanotic group, 50/90 patients required surgery. In all the patients of the cyanotic group (14/108) surgery was performed before one year of age and in seven cases second corrective surgery was performed after the age of one year.

Table I^__ Relative Frequency of Various Lesions (n = 108).

Lesion	Number	Per cent
Ventricular septal defect	29	27
Atrial septal defect	26	24
Patent ductus arteriosus	7	6
Pulmonary stenosis	9	8
Aortic stenosis	4	4
Combinations	15	14
Tetralogy of Fallot's	10	9
Tricuspid atresia	2	2
Ebsteins anomaly	1	1
Transposition of great vessels	3	3
Total anomalous pulmonary venous drainage	1	1
Total interruption of aorta	1	1

Five cases (3 cyanotic and 2 acyanotic) died in the immediate post operative period. All these five cases had complex congenital heart disease with overadded problems like severe pulmonary hypertension and/or congestive cardiac failure. Catch up growth was good and no one had any residual lesion.

Nineteen cases out of 108 (20%) had extracardiac anomalies associated with congenital heart diesease.

L. Kasturi,
A. Amin,
V.A. Mashankar,
Department of Pediatrics,
BARC Hospital, Anushaktinagar,
Mumbai 400 094, India.