Complex congenital heart defects in children in a resource constraint setting

Abstract

Background: Complex congenital heart defects (CHD) are among the non-infectious causes of childhood morbidity and mortality in developing countries, accounting for 25-30% of intensive care usage in some centers. In Abuja, the capital of Nigeria, there has been an upsurge in cases of complex CHD, thus creating the need for this study.

Objectives: The study aimed at describing the incidence and outcome of complex CHD in children seen at the University of Abuja Teaching Hospital, Gwagwalada, Abuja.

Methods: A prospective study of patients referred to the Pediatric Cardiology Unit of the hospital between 2013 and 2018 was performed.

Results: Of the 1,420 patients examined, 344 (24.2%) had CHD; 55 (16.0%) of these belong to the complex category with a male:female ratio of 1.3:1. The incidence of complex CHD is 1.1 per 1,000 live births. Tetralogy of Fallot (TOF) was the commonest form of complex heart diseases. Patients with atresic valves tend to present in the neonatal and the immediate postnatal period, while those with TOF present much later. Only 8 (14.5%) had surgical interventions, 21 (38.2%) could not afford surgery, 14 (25.5%) were lost to follow up and 10 (18.2%) died. Patients that had need of emergency cardiac surgery had the worst prognosis. Two patients with truncus arteriosus presented too late and were classified inoperable. Financial constraint and lack of facility for cardiac surgeries contributed negatively to the outcome of patients with complex heart defects.

Conclusions: Complex CHD occurred in this community with similar incidence rates as in the developed countries. The predominant complex heart defect in the locality is TOF. Defects with atresic valves carry the worst prognosis in this environment due to lack of the wherewithal to manage the condition.