6 / 70
CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 5, September/October 2016
276
AFRICA
Cardiovascular Topics
Pre-anesthetic echocardiographic findings in children
undergoing non-cardiac surgery at the University of
Benin Teaching Hospital, Nigeria
Wilson E Sadoh, Paul Ikhurionan, Charles Imarengiaye
Abstract
Background:
A pre-anaesthestic echocardiogram (echo) is
requested for most non-cardiac surgeries to identify possible
cardiac structural anomalies.
Objective:
To describe the prevalence and spectrum of struc-
tural cardiac abnormalities seen in various non-cardiac condi-
tions.
Methods:
We carried out a retrospective review of pre-anaes-
thetic echos performed over five years on children sched-
uled for non-cardiac surgery. The requests were categorised
according to referring specialities, and the biodata and echo
findings were noted.
Results:
A total of 181 children and 181 echocardiograms
were studied, and 100 (55.2%) of the patients were male. Most
of the children (87, 48.1%) with oro-facial clefts were referred
from dentistry. Of the 181 children, 39 (21.5%) had cardiac
abnormalities, most (34, 87.2%) of whom had congenital
heart disease (CHD). Ophthalmic requests with suspected
congenital rubella syndrome (CRS) had the highest preva-
lence of 8/12 (66.7%) while the lowest was oro-facial clefts at
15/87 (17.2%). Atrial septal defect was the commonest abnor-
mality, found in 14 patients (35.9%).
Conclusion:
Pre-anaesthetic echo should be performed, espe-
cially for children with suspected CRS and other congenital
anomalies, requiring non-cardiac surgery.
Keywords:
pre-anaesthetic, echocardiography, children, non-
cardiac surgery, congenital rubella syndrome, cleft lip and palate,
Nigeria
Submitted 17/7/15, accepted 26/1/16
Published online 9/9/16
Cardiovasc J Afr
2016;
27
: 276–280
www.cvja.co.zaDOI: 10.5830/CVJA-2016-006
Patients requiring non-cardiac surgery, with suspected or
symptomatic structural cardiac anomalies, may have increased
peri-operative risk.
1
This often necessitates a request for further
cardiovascular evaluation, including echocardiography (echo) as
part of the pre-anaesthetic evaluation to reduce anaesthetic risk.
1
Other patients undergoing non-cardiac surgery may have
conditions commonly associated with congenital heart diseases
(CHD), such as children with cleft lip and palate,
2
those
with suspected congenital rubella syndrome (CRS) and other
congenital malformations.
3
The presence of congenital anomalies
in one system may be associated with increased incidence
of congenital anomalies in other systems.
4
In particular, the
presence of associated CHD increases the anaesthetic risk. It
therefore becomes imperative that children with such suspected
cardiac anomalies or those with conditions commonly associated
with CHD and undergoing non-cardiac surgery are evaluated for
the presence of cardiovascular anomaly.
From studies in Nigeria, the prevalence of CHD in children
with cleft lip and palate ranges from 9.5 to 20%.
5-7
The prevalence
is higher in those with cleft palate than in those with cleft lip
only. This relatively high prevalence of CHD in children with
oro-facial cleft has prompted the policy in most centres of
pre-anaesthetic echo for all such patients.
Congenital rubella syndrome is characterised by a triad of
deafness, cataract and cardiac malformation.
8
Affected children
with cataract, which is the commonest ocular manifestation,
would prompt presentation to the ophthalmologist. The
children are referred for cardiovascular evaluation, including
echocardiography, to confirm or exclude possible cardiac
anomalies. Although a variety of CHDs have been found in
children with CRS, patent ductus arteriosus (PDA) tends to be
the predominant CHD reported.
9
Adenotonsilar hypertrophy (AH) is a common cause of
obstructive sleep apnoea syndrome and other sleep disorders in
childhood.
10
This is a common childhood presentation to ear,
nose and throat (ENT) surgeons. Commonly associated with AH
are ventricular hypertrophy and other rhythm abnormalities that
may increase anaesthetic risk during adenotonsilectomy.
11
Following the increasing availability of echocardiographic
services in the country, some patients being prepared for non-cardiac
surgeries are referred for pre-anaesthetic cardiovascular evaluation,
including echo. The cost of echo is often high and this increases the
cost of surgery. This study was conducted to describe the prevalence
and spectrum of structural cardiac abnormalities seen in the children
with various non-cardiac conditions, referred to our echo laboratory.
Department of Child Health, University of Benin Teaching
Hospital, Benin, Nigeria
Wilson E Sadoh, MB BS, FWACP, MPH,
sadohehi@yahoo.comPaul Ikhurionan, MB BS
Department of Anesthesiology, University of Benin
Teaching Hospital, Benin, Nigeria
Charles Imarengiaye,MB BS, FWACS