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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 5, September/October 2016
278
AFRICA
17 females (43.6%). The median age of the 39 children was 1.1
years (range: 2 days to 16 years). The distribution of the 39
children with cardiac abnormalities according to the referring
departments is shown in Table 2. The highest percentage of
cases with cardiac abnormalities was in patients referred from
ophthalmology (9/20, 45.0%).
Of the 34 children with CHD, 31 (91.2%) had acyanotic
CHD while three (8.8%) had cyanotic CHD. The commonest
cardiac abnormality was isolated atrial septal defect (ASD) in
14 cases (35.9%), followed by isolated patent ductus arteriosus
(PDA) in seven (17.9%). The cardiac abnormalities in the group
with cyanotic CHD were tetralogy of Fallot, two cases (one was
repaired), and one case of single ventricle. The distribution of
cardiac abnormalities by referring department/speciality is given
in Table 3.
Twelve children had suspected congenital rubella syndrome
with cataract, and eight (66.7%) of these had cardiac
abnormalities. They were all CHD cases and consisted of three
with ASD (37.5%), three with PDA (37.5%), one with ventricular
septal defect (VSD) (12.5%) and one with atrioventricular septal
defect (AVSD) (12.5%).
Most (87, 96.7%) of the 90 children referred from dentistry
had cleft lip or palate. Of the 87 cases, 38 (43.7%) had cleft lip
only, cleft palate only was present in 20 (23.0%), and cleft lip
and palate was present in 29 children (33.3%). Of the 90 cases,
15 children (16.7%) had cardiac anomalies, and all were CHD.
Of the three categories of oro-facial cleft, the highest
proportion of CHD was found in children with cleft lip and
palate (7/29, 24.1%), compared to children with cleft palate only
(4/20, 20.0%), and those with cleft lip only (2/38, 5.3%). There was
a significantly higher proportion of CHD in children with any
form of cleft palate (12/49, 24.5%), compared to those with cleft
lip only (2/38, 5.4%) (
p
=
0.019, OR
=
5.8, 95% CI
=
1.2–27.9).
The distribution of type of CHD among children with different
types of cleft lip and palate abnormalities is shown in Table 4.
No cardiac abnormality was seen in the case referred for
echocardiography prior to stem cell transplantation. Among
the children with ventricular hypertrophy, three with RVH were
referred for evaluation for adenoidectomy. Two others with
LVH were cases of Wilm’s tumour and Burkitt’s lymphoma,
referred for evaluation for biopsy under general anaesthesia. The
rest of the children from other units who had CHD consisted
of two cases of omphalocoele, two with anorectal anomalies
(Hirshsprung and imperforate anus), and a case of repaired
tetralogy of Fallot requiring hernia repair.
Of the 46 children referred from other units, 28 (60.9%) had
a form of congenital anomaly. Of the 28, five (17.9%) had CHD
and none of the 18 without congenital anomaly had CHD. The
difference was however not statistically significant (
p
=
0.14, OR
=
7.1, CI
=
0.37–137.20).
The median (range) FS and EF values of the study population
were 38.0% (28.5–57.0) and 70.0% (56.8–81.1), respectively.
Table 5 shows the FS and EF values of the study population
by referring specialities. There was no statistically significant
difference between FS and EF values by specialities (
p
=
0.48 and
0.70, respectively for FS and EF).
The median (range) FS values of children with and without
cardiac abnormalities were 35.0% (31.7–44.3) and 37.8% (28.0–
49.0), respectively (
p
=
0.64). The median (range) EF values of
children with and without cardiac abnormalities were 67.3%
(61.2–79.3) and 70.2% (56.8–81.1), respectively (
p
=
0.73).
Discussion
In this study, 21.5% of children presenting for pre-anaesthetic
echo for non-cardiac surgery had cardiac anomalies. The
percentage in our study is lower than the 35% obtained in a study
by Oyati
et al
. in Zaria,
15
Nigeria, on children with non-cardiac
congenital anomalies. The lower value in our study may have
been due to the lower proportion of children with congenital
anomalies in our study.
There is a higher risk of concurrent congenital anomalies,
including CHD, in children with congenital anomalies.
4
The high
value of echocardiographically confirmed cardiac anomalies in
our study supports the continued practice of echocardiography
for such children, considering the increased anaesthetic risk that
the presence of cardiac malformation may present.
The 16.7% prevalence of CHD in children with cleft lip
and palate in our study is consistent with the 15% recorded by
Otaigbe
et al
.
6
in Port Harcourt, Nigeria, but lower than the
20% obtained in a similar study in Kano.
7
The latter two studies
consisted of small sample sizes and may have precluded drawing
strong inferences from the studies, compared to our study with a
sample size of 87 children.
Table 3. Distribution of the type of cardiac
abnormalities by referring specialities
Referring
speciality
ASD PDA VSD AVSD
ASD/
VSD
ASD/
PDA
Ventricu-
lar hyper-
trophy CCHD Total
Dentistry
7 3 3
–
–
1
–
1 15
ENT
1 – 1
–
–
–
3
–
5
Ophthalmology 3 4 1
1
–
–
–
–
9
Other units
3 – –
2
1
–
2
2 10
Stem cell transplant
Total
14 7 5
3
1
1
5
3 39
ASD
=
atrial septal defect, PDA
=
patent ductus arteriosus, VSD
=
ventricular
septal defect, AVSD
=
atrioventricular septal defect, CCHD
=
cyanotic congenital
heart disease, ENT
=
ear nose and throat.
Table 4. Distribution of the type of cardiac abnormalities
in children with cleft lip/palate
Type of CHD Cleft lip
Cleft palate Cleft lip/palate
Total
ASD
1
2
3
6
PDA
–
–
2
2
VSD
–
2
1
3
PDA, ASD
–
–
1
1
TOF
1
–
–
1
Total (%)
2 (15.4)
4 (30.8)
7 (53.8)
13 (100.0)
CHD
=
congenital heart disease, ASD
=
atrial septal defect, PDA
=
patent
ductus arteriosus, VSD
=
ventricular septal defect, AVSD
=
atrioventricular
septal defect, TOF
=
tetralogy of Fallot.
Table 5. Median values of fractional shortening and ejection fraction
by referring specialities
Referring
specialities
Fractional shortening
median (range)
p
-value
Ejection fraction
median (range)
p
-value
Dentistry
38.0 (43.0–49.0)
0.48 70.0 (64.2–81.1)
0.70
ENT
36.5 (29.0–40.0)
67.6 (59.0–72.9)
Ophthalmology 37.3 (34.0–40.0)
68.7 (65.4–72.0)
Other units
37.5 (28.0– 47.2)
71.7 (56.8–79.8)
*
p-
values for the difference in median fractional shortening and ejection frac-
tion values between specialities. ENT
=
ear nose and throat.