Context: Several studies were conducted throughout the world on heart diseases in children; no data is available in Congolese child. Objective: To evaluate epidemiological profile of Congolese children and teenager carrying cardiovascular diseases. Methods: A descriptive and prospective study was carried out during 4 years in the pediatric department of teaching hospital of Brazzaville, near the children received in consultation of pediatric cardiology. Results: On 41,472 patients admitted in pediatric service, 526 patients were received in consultation for suspicion of heart diseases. Among them, 444 had cardiopathy (incidence of 10.7‰). It was about a congenital heart disease to 316 (60%) incidence of 7.6‰; Acquired heart disease to 128 (24.4%) incidence of 3.1‰. Among congenital heart defects observed frequency of patients with ASD was 20.3%, isolated in 10.1% of cases, and associated with ECD (11.8%). The VSD was observed in 30.1% of cases, and the Tetralogy of Fallot in 10.1% of cases. Among the acquired heart diseases, severe hypo kinetic dilated cardiomyopathy (DCM) was noted in 24.4% of cases. The rheumatic heart diseases accounted for 41.4% of cases. It was mitral regurgitation (33.6%), a mitral stenosis (1.6%). Pericarditis was objectified at 10.1% of the patients. The evolution was favorable for 43.3% of patients. An aggravation of symptoms was observed to 2.7% of patients. Mortality was 11.9% and 71.9% of deaths were observed to not operate carriers of congenital heart disease. 69.9% of dead patients were carrying a cyanogen heart disease. Left to right shunt represented 21.7% of the deaths. Conclusion: Heart diseases are real problem of public health for Congolese children.
The heart diseases are various origins. Being able congenital or to be acquired, they touch nearly 1% of the population with regard to congenital heart diseases and 5% of the children in others countries as regards the acquired forms [
The study, descriptive and prospective, was carried out with the teaching hospital of Brazzaville. Patients aged 0 - 15 years received in consultation of pediatric cardiology during the period of 1st June 2009-1st June 2013. The population of Brazzaville, for this period, was 1,373,382 inhabitants.
The present work reports on 526 consecutive Congolese young patients admitted or followed up in teaching hospital of Brazzaville. The two-dimensional echocardiography, carried out with an apparatus portable Doppler color (Mr.-Turbo Sonosite, Bothell, USA) was done for all the patients. The interest data were age, gender, reason for consultation, type of cardiopathy, existence or not of an operational indication, existence or not of a surgical assumption of responsibility and evolution.
They were noted on individual record sheets of collection. We used Epi Info version 6.5.1 (WHO & CDC) to enter and clean the data, and SPSS (Statistical Package for Social Science) version 16.0 (SPSS Inc, Chicago, IL, USA) to analyze the data. The p-value, less than 0.05, was regarded as the statistical threshold of significance. The quantitative information was expressed on average accompanied by the standard deviation, the frequencies in the form of percentages. Chi square and Sokal tests were used for comparing categorical and qualitative variables. The comparisons between various groups of heart diseases, like between sex and groups of ages, were carried out using the test of the χ2 of Spearman when indicated.
For the period of study, the number of consultations to the teaching hospital rose with 68,352 patients, including 41,472 patients in pediatry (60.7%). On the whole, 526 patients were received in pediatric consultations of cardiology (1.3%). The present serie comprised 284 (54%) girls and 242 (46%) boys (sex ratio of 0.85). The average age of the patients was 2053 days, either 5 years 7 months (2109 days or 8 months for the girls; 1997 days either or 5 months for the boys) with range: 4 days - 5400 days (15 years). The distribution of the patients according to the age is reported in
The reasons for consultation were summarized with the appearance of a respiratory distress in 26.6% of cases; respiratory distress associated a murmur heart in 8.2% of
Age bracket (days) | Girls (n) | Boys (n) | Total (n) | Frequency (%) |
---|---|---|---|---|
0 - 90 | 51 | 42 | 93 | 17.7 |
91 - 360 | 74 | 52 | 126 | 24.0 |
361 - 1080 | 52 | 42 | 94 | 17.9 |
1081 - 2160 | 38 | 49 | 87 | 16.6 |
2161 - 3240 | 20 | 22 | 42 | 8.0 |
3241 - 4320 | 24 | 19 | 43 | 8.2 |
4321 - 5400 | 25 | 16 | 40 | 7.6 |
Total | 284 | 242 | 526 | 100 |
Reasons | Number | frequency % |
---|---|---|
Dyspnea | 140 | 26.6 |
Dyspnea with heart murmur | 43 | 8.2 |
Heart murmur | 97 | 18.4 |
Cyanosis | 27 | 5.1 |
Chimiotherapy | 27 | 5.1 |
Follow up of known cardiopathy | 108 | 20.6 |
Cardiomegaly | 11 | 2.1 |
Down syndrome | 11 | 2.1 |
Arrhythmia | 11 | 2.1 |
Poly malformatif syndrome | 18 | 3.4 |
Chest pain | 10 | 2.0 |
Kawasaki disease | 6 | 1.1 |
Poor growth | 11 | 2.1 |
Pre operative assessment | 6 | 1.1 |
Total | 526 | 100 |
cases, perception of murmur heart in 18.4% of the cases. The assessment of cyanosis and therapeutic pre-assessment for an anti-cancer chemotherapy were the reasons for consultation in 5.1% of cases. In addition, 20.6% of patients consulted within the framework of the follow-up of a known cardiopathy from which 18.4 % had already profited from a surgical assumption of responsibility. The discovery of a cardiomegaly on radiographies of thorax, the assessment of Down syndrome, arrhythmias were found respectively in 2.1% of cases. The assessment of polymalformative syndrome justified the consultation in 3.1% of cases. The other reasons for consultation were pains of left hemi thorax, suspicion of syndrome of Kawasaki, presence of hypotrophy, or preoperative assessment at homozygous sickle cell diseases (
On the whole, 82 (15.6%) patients presented a normal aspect of the heart. However, 444 patients had cardiopathy with an incidence of 10.7‰. It was about congenital heart diseases at 316 (60%) patients either an incidence of 7.6‰ and acquired heart diseases at 128 (24.4%) patients with an incidence of 3.1‰.
The population of the patients with congenital heart diseases comprised 173 girls and
Age bracket (days) | Girls (n) | Boys (n) | Total (n) | Frequency (%) |
---|---|---|---|---|
0 - 90 | 38 | 31 | 69 | 21.9 |
91 - 360 | 64 | 36 | 100 | 31.7 |
361 - 1080 | 37 | 33 | 70 | 22.2 |
1081 - 2160 | 18 | 26 | 44 | 14.0 |
2161 - 3240 | 6 | 6 | 12 | 3.8 |
3241 - 4320 | 5 | 6 | 11 | 3.5 |
4321 - 5400 | 5 | 5 | 10 | 2.8 |
Total | 173 | 143 | 316 | 100 |
143 boys (sex-ratio to 0.83). The average age bordered 2087 days is 7 months (range: 4 - 15 years). The old patients aged to 0 - 3 years represented 75.9% of manpower; moreover, 53.6% of patients were less than one year old. The patients of more than 12 years represented 7.3% of manpower.
The atrial septal defect (ASD) was objectified in 20.3% of the cases (
Among the 27 patients with Down syndrome 19 girls and 8 boys were found (sex-ratio to 0.42). Ten eights of these patients were carrying endocardial cushion defect (ECD), that is to say 66.7% of patients with Down syndrome; they were 14 girls and 4 boys versus 5 carriers of ECD among patients without Down syndrome. Association the ASD ostium secondum and ECD was observed only among 8 patients with Down syndrome (44.4%). Other cardiac malformations were observed on this ground: the ASD ostium secondum insulated among two patients, the ASD ostium secondum and VSD perished membranous in two cases, VSD perished membranous and PDA at a patient, VSD insulated among three patients. A patient presented a heart without anomaly, (3.7 % from Down syndrome).
A syndrome of Noonan was observed among three carrying patients presented respectively pulmonary valvular stenosis, VSD of type III with PDA and ASD ostium secondum. In addition, two patients of same fratry were carrying a severe hypokinetic dilated cardiomyopathy of origin family (form related to X).
Type of heart defects | Girls (n) | Boys (n) | Total (n) | Frequency (%) |
---|---|---|---|---|
ASD | 37 | 27 | 64 | 20.3 |
ASD insulated | 21 | 12 | 33 | 10.5 |
Associated to: VSD | 6 | 8 | 14 | |
ECD | 6 | 2 | 8 | |
PDA | 1 | 2 | 3 | |
DORV | 0 | 1 | 1 | |
PS | 3 | 1 | 4 | |
PAIVS | 1 | 1 | 2 | |
VSD | 46 | 49 | 95 | 30.1 |
VSD insulated | 40 | 37 | 77 | 24.4 |
Associated to: TGA | 2 | 2 | 4 | |
PS | 2 | 4 | 6 | |
PDA | 1 | 5 | 6 | |
AR | 0 | 1 | 1 | |
Dextrocardy | 1 | 0 | 1 | |
ECD | 16 | 8 | 24 | 7.6 |
insulated | 9 | 1 | 10 | 2.2 |
Associated to: ASD os | 6 | 2 | 8 | |
PDA | 1 | 1 | 2 | |
DORV | 0 | 3 | 3 | |
aorto ventricular chanel | 1 | 0 | 1 | |
Pulmonary atresia | 0 | 1 | 1 | |
PDA | 21 | 16 | 37 | 11.7 |
Associated to: ECD | 1 | 1 | 2 | |
VSD | 2 | 5 | 7 | |
Tetralogy of Fallot | 0 | 1 | 1 | |
ASD | 1 | 2 | 3 | |
DORV | 3 | 4 | 7 | 2.2 |
Associated to: PS | 2 | 0 | 2 | |
PDA | 1 | 0 | 1 | |
SV | 1 | 1 | 2 | 0.6 |
Associated to: PTA (persistent truncus arteriosus) | 0 | 1 | 1 | |
Hypoplatic left heart | 2 | 1 | 3 | 0.6 |
Associated to: GAT | 1 | 0 | 1 | |
GAT | 1 | 2 | 3 | 0.9 |
Associated to: VSD | 0 | 1 | 1 | |
Hypoplastic left heart | 0 | 1 | 1 |
ASD: atrio septal defect; ECD: endocardial cushion defect; VSD: ventricular septal defect; GAT: great artery transposition; PS: pulmonary stenosis; AR: aortic regurgitation; DORV: double-outlet right ventricle; PAIVS: pulmonary atresia with intact ventricular septum; PAVSD: pulmonary atresia with ventricular septal defect; PDA: patent ductus arteriosus.
Girls (n) | Boys (n) | Total (n) | Frequency (%) | |
---|---|---|---|---|
Tetralogy of Fallot | 12 | 20 | 32 | 10.1 |
Associated to: PDA | 1 | 0 | 1 | |
PS | 21 | 10 | 3 | 29.8 |
Insulated | 15 | 7 | 22 | 7.0 |
Associated to: DORV | 2 | 0 | 2 | 0.6 |
VSD | 2 | 4 | 6 | |
ASD | 3 | 1 | 4 | |
PAVSD | 4 | 7 | 11 | 3.5 |
PAIVS | 0 | 1 | 1 | 0.3 |
Ebstein’s anomaly | 2 | 0 | 2 | 0.6 |
pulmonary ectasia | 0 | 1 | 1 | 0.3 |
cor Triatriatum | 0 | 1 | 1 | 0.3 |
PTA | 1 | 4 | 5 | 1.6 |
Associated to: SV | 0 | 1 | 1 | 0.3 |
long QT syndrome | 0 | 1 | 1 | 0.3 |
Rabdomyoma of tuberous sclerosis of Bourneville | 1 | 0 | 1 | 0.3 |
They were found among 68 girls and 60 boys (sex-ratio to 0.88). The average age of these patients was 2012 days (5 years 5 months). Among them, 82.8% of the patients were old of more than 3 years.
The severe hypokinetic dilated cardiomyopathy was noted in 24.2% of cases and they were observed in all the age brackets. The rheumatic heart diseases represented 41.4% of cases. Their incidence in the population of child received at the teaching hospital of Brazzaville for the period of study was 1.1‰. These rheumatic heart diseases were observed as of 3 years. The lesions observed were mitral regurgitation (MR) in 3.6 % of cases (43 patients), associated to aortic regurgitation among 2.3 % of patients (3 cases) and mitral stenosis (MS) in 1.6% of cases (
A suffering patient of an infection with AIDS was carrying a myocarditis.
Age bracket (days) | Girls (n) | Boys (n) | Total (n) | Frequency (%) |
---|---|---|---|---|
0 - 90 | 3 | 3 | 6 | 4.7 |
91 - 360 | 5 | 3 | 8 | 6.2 |
361 - 1080 | 4 | 4 | 8 | 6.2 |
1081 - 2160 | 15 | 16 | 31 | 24.2 |
2161 - 3240 | 8 | 14 | 22 | 17.2 |
3241 - 4320 | 16 | 10 | 26 | 20.3 |
4320 - 5400 | 17 | 10 | 27 | 21.1 |
Total | 68 | 60 | 128 | 100 |
Type of heart diseases | Total | Frequency |
---|---|---|
Myocarditis | 3 | 2.3 |
Myopericarditis | 4 | 3.1 |
Péricarditis | 13 | 10.1 |
Bacterian endomyopericarditis | 1 | 0.8 |
Rheumatismal pancarditis | 2 | 1.6 |
Rheumatismal valvulopathies: | ||
MR | 40 | 31.2 |
Mitral disease | 1 | 1.6 |
MR+AR | 3 | 2.3 |
Dilated cardiomyopathies: | ||
Hypokinétique sévère | 31 | 24.2 |
Cardiomyopathie whith SSD | 11 | 8.6 |
Fibrosis endomyocarditis | 1 | 0.8 |
Hypertrophic cardiomyopathies | 1 | 0.8 |
Primitive pulmonary hypertension | 2 | 1.6 |
On the whole, 240 patients (45.7%) had an operational indication. Among them 103 were operated (42.9% of cases) thanks to French ONG (Chain of the Hope, cardiac Mécénat surgery). A total of 6 pericardial drainages had been carried out in local surgical medium. Moreover, 137 other patients were in waiting of surgical assumption of responsibility. However, 19 patients, because of existence of Down syndrome were not
eligible for an assumption of responsibility by the ONG, like 7 patients carrying a systemic pulmonary hypertension.
The evolution could be specified only for 261 patients (49.7% of cases). The evolution was favorable among 113 patients (43.3%), stable at 69 patients (26.4%). An aggravation of symptoms was noted among 7 patients, (2.7% of cases). Mortality frequency was 11.9% is 31 patients: 19 girls and 12 boys. In addition, 71.9% of the deaths were observed among not operated patients carrying congenital heart diseases. Moreover, 69.6% of patients deceased (n = 16) were carrying a cyanotic congenital heart defects: PAVSD, 4 cases; PAISV, 1 case; Tetralogy of Fallot, 5 cases; TGA, 3 cases; Hypoplastic left heart, 2 cases; DOVR, 1 case. The heart defect with left to right shunt accounted for 21.7% of the deaths (5 cases); 8.69% of these deaths were observed among patients carrying a tight pulmonary stenosis. Last nine deaths were noted among patients carrying an acquired heart disease: 4 patients carrying a rheumatic valvulopathy, 3 of péricarditis, 2 of a severe hypokinetic dilated myocardiopathy. Moreover, two patients had died respectively: of oil ingestion and a neurological malaria, their cardiopathy not being the cause of their death. The average age of the patients deceased was 758 days is 2 years 10 months for congenital heart diseases (range: 4320 - 3176 days).
Our study, in spite of skews related to its hospital character, makes it possible to have an idea on the frequency and the types of heart diseases observed in Congolese pediatric medium. The numbers of heart diseases recruited in 4 years is more significant than those noted in studies former carried out to Congo in pediatric medium [
Contrary to the observations of Kinda et al. [
With regard to the reasons for consultation, the respiratory embarrassment and the heart murmur were the principal reasons for consultation in our series, followed cyanosis. Kinda et al. [
In Europe particularly in France, the antenatal diagnosis of congenital heart diseases has more than 25 years [
As observed before [
In addition, the girls with ECD were higher than boys (16 cases against 8 cases), as described by Gnansia et al. [
As for acquired heart diseases, they were observed than the congenital ones as other authors [
Being the rheumatic valvulopathies, they were the first motivation of cardiopathy acquired in our series (41.4% of cases), as in the studies of Affagla et al. [
The severe hypokinetic dilated cardiomyopathy occupy the second rank of the acquired heart diseases in our series (24.2%). Bode et al. [
The hypokinetic dilated cardiomyopathy, in our series, were observed in all the age brackets. Noted as of the neonatal period, these very early cardiomyopathy could be secondary with neonatal myocarditis, myocardial ischemia post anoxic or endomyocardic fibrosis [
One of our patients suffering from AIDS presented a myocarditis. Indeed, the cardiac diseases became a significant factor of AIDS; approximately 2.1% to 7.5% of the people reached of AIDS suffer from a significant cardiac failure [
Our data report that half of the patients having an operational indication could profit from surgical assumption of responsibility primarily in France thanks to no governmental french organizations (ONG) (Chain of the Hope, Cardiac Mecenat Surgery). Indeed, as observed by other authors [
The evolution could be specified only for about half of the patients. Indeed, the absence of medical unit dedicated to the pediatric cardiology explains variability of patients in the four pediatrics services which account the teaching hospital of Brazzaville.
Lastly, 23 deaths were noted among patients with congenital heart diseases, primarily at not operated. The cyanotic congenital heart defects were lethal: 16 reports among 23, i.e. 69.6% of the deaths. This higher lethality was also observed by Rasamoelisoa et al. [
Although occulted in sub-Saharan Africa, heart diseases of the child are a real problem of public health because of their importance and the difficulties of assumption of responsibility related on poverty of technical plates and lack of specialists in cardiovascular surgery for the forms requiring a surgical assumption of responsibility. And the equipment staff training out of apparatus of echography Doppler color would contribute to the diagnosis and the early assumption of responsibility of its patients. It will be convenient to consider the creation of a center of surgical assumption of responsibility of these heart diseases, being able to be integrated in an existing national structure or into vocation under regional. As for the rheumatic heart diseases, first cause of acquired heart diseases, their prevention by education and treatment correct of the streptococcus anginas as well as the improvement of the conditions of hygiene could reduce the frequency like that of it was observed in the developed countries or these pathologies became rare.
M’pemba Loufoua- Lemay, A.B. and Massamba, A. (2016) Epidemiology of Cardiovascular Diseases in Chi- ldren at the Teaching Hospital of Brazzaville, Congo. World Journal of Cardiovascular Diseases, 6, 410-424. http://dx.doi.org/10.4236/wjcd.2016.611045