Introduction: The management of congenital heart diseases in countries with limited technical facilities poses real problems to practitioners. Yet, a good medical follow- up permits to improve these children’s life quality before any eventual surgery. Our study aims at examining the evolutionary and prognostic aspects of these congenital heart diseases in order to understand their evolution in our context. Materials and Methods: Our work is a continuation of a prospective, transversal and descriptive survey concerning all the children with congenital heart diseases in hospitalization or in consultation led from January 1s t 2012 to December 31st 2012 in the Charles De Gaulle Center Pediatric Teaching Hospital (CDG-PTH) in Ouagadougou. Results: In 2012, we kept under observation 101 cases of congenital heart diseases representing 69.18% of the 146 cases of heart diseases with an impact of 0.79% of the 12,838 patients who were admitted at CDG-PTH. The interventricular septal defect occupied the first place of all malformative heart diseases with 43.56% of cases. The average age of patients at the moment of the diagnosis was 17 months old with extremes ranging from two (2) days old to fifteen (15) years old. The sex-ratio was 1.06. Throughout the follow-up of the children until the end of the six months’ survey, it was possible for us to meet again 52 patients, we had no longer been in touch with 22 patients and 27 were dead. At the moment of the diagnosis, surgical treatment was recommended for 63.37% of the patients (64 cases) and only 7.81% (5 cases) were operated. The complicated cases were: Eisenmenger syndrome (6 cases representing 5.94%). We recorded a rate of 26.73% of death. Conclusion: Congenital heart diseases are relatively common at CDG-PTH. The high rate of mortality noticed is due to the lack of heart surgery and catheterism units in our country.
Congenital heart diseases are cardiovascular malformations present at birth and caused by a failure of development during the life of the embryo [
In order to know more about child’s congenital heart diseases, a prospective survey has been initiated at CDG-PTH in 2012 in the framework of our work.
Our work, which is a continuation of this survey, aims at studying the progressive and prognostic aspects of these infections [
Our target population was made up of hospitalized or consulted children aged between zero and fifteen years, who presented clinical signs of congenital heart disease and where Echocardiography Doppler permitted to confirm the diagnosis between January 1st and December 31st 2012 congenital heart diseases. All children are descended of an African black population. Each child was then observed for sixteen (16) months according to his/her inclusion date. So, patients included in January 2012 were observed until April 2013 and those integrated in December 2012 were observed until April 2014. The variables included for analysis were age, sex, Down syndrome, the comparison of the signs between the time of the diagnosis and some at the end of survey (respiratory distress, thoracic deformation, digital hippocratism, arythmia, electric hypertrophia, cardiomegalia, radiographic bronchopneumopathy), the intervening of complications (endocarditis, Eisenmenger, death). The collected data were type-written and analyzed thanks to softwares “Epi info version 3.5.1” and “SPSS 21”. To compare the data we used the exact test of Fisher with statistical significations of proportion being inferior to 0.05. The graphs were made with excel. Oral consent was given by one the parents. The child was always consulted with his parent. Patient could refuse to participate to the study without influence in his follow up.
In 2012, we examined 146 cases of heart diseases out of a total of 12 838 patients which represents a percentage of 1.14%. Congenital heart diseases which were 101 represent 69.18% of all the cases with an incidence of 0.79%.
Out of the 101 cases, fifty-two (52) were really surveyed for sixteen (16) months, twenty-two (22) lost touch with us and twenty-seven (27) died.
The average age of patients was seventeen (17) months with extremes ranging from two (2) days to fifteen (15) years. Infants were the most numerous with sixty-four (64) cases and a percentage of 63.37% followed by new born with twenty-six (26) cases representing a percentage of 25.74%.The majority was boys with a sex ratio of 1.06.
Dyspnea was the most common discovery during the diagnosis of congenital heart diseases with sixty-seven (67) cases and a percentage of 66.34%. At the last check-up, the heart breath was the clinical sign the most frequent encountered with twenty-five (25) cases out of fifty-two (52) patients and a percentage of 48.08% compared to forty ?two cases (80.77%) in 2012.
Besides, the respiratory distress was observed in five (5) cases with 9.62% compared to thirty-six cases (69.23%) in 2012. However, we had observed six (6) cases (11.54%) of digital hippocratism compared to two (2) cases (3.85%) in 2012 and the appearance of thoracic deformation with four (4) children. The congenital malformation related to the most congenital heart diseases was “Down syndrome” noticed in ten (10) cases representing 9.90% with an association of atrioventricular canal (6 cases). Out of the fifteen (15) cases of atrioventricular canal we noticed six (6) patients with Down’s syndrome facies (40%)
In 2012, electrocardiogram was carried out on thirty-six (36) patients and twenty-four (24) abnormalities were noticed with nine (9) cases of right ventricular hypertrophy.
At the last check-up, we carried out an electrocardiogram on sixteen (16) patients and we recorded one (1) case of bi-ventricular hypertrophy and one (1) case of isolated left ventricular hypertrophy and each represented a percentage of 1.92%.
During the diagnosis, the front chest x-ray was carried out on thirty-three (33) patients and there were thirteen (13) cases of cardiomegaly representing 12.92%. The other anomalies namely the modification of the cardiac sides and radiographic bronchopneumopathy were ten (10).
The x-ray carried out on twenty (20) patients during the last check-up permitted to isolate five (5) cases of cardiomegaly (9.52%).
The most common complication was Eisenmenger’s syndrome which could be seen on six (6) patients (5.92%) followed by endocarditis, encephalophyosis and arythmia.
Out of the fifty-two (52) patients who are still alive and who were surveyed up to the end, the situation of forty of them (76.92%) was estimated to be good whereas it was supposed to be bad for the other twelve (23.08%).
As for cases of atrioventricular canal and complex congenital heart diseases (interventricular septal defect, single auricle, single ventricle, “mitral Artesia “, double outlet right ventricle) the prognosis was generally bad
In our survey, congenital heart diseases had a hospital impact of 0.79%. This number is superior to those of Himmetoglu in Turkey [
The important variation of the incidence rate of these malformations could be explained by the inclusion criteria and the age of the patient during the diagnosis. In fact, it is easy for some interventricular canal defect and atrial septal defect of small size to heal during the first years of life. The means used for the diagnosis, the size of the samples and the setting could also have an impact on the incidence.
As for congenital affections, congenital heart diseases can be discovered at different ages of life. During our survey, the average age of patients was seventeen (17) months old with extremes ranging from two (2) days old to fifteen (15) years old. Our result is close to Sawadogo’s [
We noticed a male predominance with fifty-two (52) boys (51.49%) compared to forty-nine (49) girls (48.51%) representing a sex-ratio of 1.06.The same fact was noticed by Diop [
Different symptoms can motivate parents to send their children to hospital for consultation. In our series, Dyspnea was the most common discovered circumstance with 66.34%. The same observation was made by Sawadogo [
The evolution of the sick persons kept under observation was assessed at the clinical and paraclinical level and in accordance with therapeutic data. At the end of the survey, the cardiac breath was the most common sign during the examination of the fifty-two (52) patients observed with 48.08% compared to 80.77% at the moment of the diagnosis. The same observation was made in previous survey. Thalboussouma in Burkina- Faso [
These results could be explained by the fact that the cardiac breath is a quasi-existent sign in heart diseases [
During the diagnosis of the fifty-two (52) patients in 2012, the respiratory distress was the most common clinical sign with 69.23% after the heart murmur which represented 80.77%. Nadia and her collaborators in Pakistan [
We noticed a decrease in the frequency of the respiratory distress ranging from 69.23% at the moment the diagnosis in 2012 to 9.62% at the end of the survey with the fifty-two (52) patients. On the other hand, the frequency of finger hippocratism went from 3.85% to 11.54%. This observation could show the clinical improvement for some children but also the evolution towards pulmonary arterial hypertension for others, causing thus the persistence of chronic hypoxia and reducing the intensity of dyspnea. We noticed the appearance of thoracic deformation with four (4) children who were suffering from chronic respiratory distress. In fact, when subjected to intensive efforts and/or permanent respiratory movements, the thorax ends up by adopting a vicious shape. Congenital heart diseases are often associated with other types of malformations. Atrioventricular canal is a common heart disease in trisomy of chromosome 21 [
In these situations, the etiologies of congenital heart diseases are probably due to genetic anomalies namely chromosomal aberrations.Trisomy of chromosome 21 is one of the chromosomal aberrations the most common because it is the most viable form. The pleiotropic action of genes could explain the frequency of malformative associations. As a matter of fact, the highlighting of one or several visible congenital heart diseases of a child must always be subjected to a research of other anomalies mainly visceral. At the moment of the diagnosis, out of the 101 patients, only 36 were able to do an electrocardiogram which highlights 21cases of anomalies with 8.91% of right ventricular hypertrophy. At the last check-up, sixteen (16) patients out of fifty-two (52), had benefited from an electrocardiogram that was pathological in two cases (a bi-ventricular hypertrophy and a left-ventricular hypertrophy representing each a percentage of 1.92%).
The front chest x-ray carried out only on thirty-three (33) children revealed a cardiomegaly in 12.87% of the cases at the moment of the diagnosis. Out of the fifty-two (52) patients consulted again in 2014, this test was carried out on twenty (20) cases and 9.62% of the patients were suffering from a cardiomegaly. Kinda [
During the follow-up as well as at the moment of the diagnosis, the majority of the patients were under drug therapy with respectively 63.37% and 51.92%. The most prescribed drugs in 2012 were Furosemide (22 cases representing 42.31%) and potassium (20 cases representing 38.46%) and respectively 21 cases (40.38%) and 20 cases (38.46%) in 2014. Kinda [
However, some patients whose clinical aspect did not require any drug therapy did not receive any. Yet, a regular monthly or quarterly check-up was always necessary for all the patients. The surgical treatment remains the curative treatment for congenital heart diseases. In our case it was recommended for 63.37% of the patients (64 cases) in 2012 and only 7.81% (5 cases) had undergone a surgery. This number is close to Kinda’s in Senegal [
These deaths highlight the importance of surgery in the management of malformative heart diseases and the necessity of creating an operating center for cardiovascular surgery which is accessible to populations in all developing countries. An analysis of the fifty-two (52) cases of children kept under observation till the end of the survey in 2014 revealed that only one (1) patient had an unsteady clinical status in 2012 whereas the other fifty-one (51) who represented 98.08% had a steady status. Yet, in 2014, it was possible to realize the filling of this child‘s intraventricular septal defect thanks to Doppler echography. A spontaneous recovery was noticed with eleven (11) other children and a recovery after surgery was with three (3) children. We noticed that more than half of the cases of isolated atrial septal defect (57.14%) were progressing spontaneously towards recovery. This result corroborates Fischer and his collaborators’ in Austria [
Congenital heart diseases are relatively common at CDG-PTH. The sixteen months’ follow-up of 101 cases diagnosed in 2012 allowed us to notice that they generally had bad diagnosis with 27 cases of death (representing 27%), 22 cases we were no longer in touch with and only fifty-two (52) children were seen again. The tolerance at the clinical level was bad in 5.77% of the cases where we had iterative appearance of complications and decompensation. The high rate of mortality noticed is due to an unmet health need, namely heart surgery and catheterism intervention, which is not available in our country.
Kinda, G., Kologo, K.J., Bama, A., Millogo, G.R.C., Traoré, S., Dao, L., Yougbaré, S.O., Kaboré, A., Kaboret, S., Nagalo, K., Tamini, L.T., Yaméogo, R.A., Kouéta, F., Yé, D., Sorgho, L.C.L. and Zabsonré, P. (2016) Child’s Congenital Heart Diseases: A Follow-Up of 101 Cases at Charles De Gaulle Pediatric Teaching Hospital (CDG-PTH) of Ouagadougou. Open Access Library Journal, 3: e3092. http://dx.doi.org/10.4236/oalib.1103092