Masood Sadiq, Bakht Roshan, Asjad Khan, Farhan Latif, Irfan Bashir, Sheryar A Sheikh.
Pattern of Paediatric Heart diseases in Pakistan.
J Coll Physicians Surg Pak Jan ;12(3):149-53.

Objective: To assess the pattern, age distribution and relative incidence of heart diseases in pediatric patients aged 16 years and less. Design: A five-year analysis of all children undergoing echocardiography for possible heart disease in a single center. Setting: Tertiary referral center for pediatric and adult cardiac services in the central and southern Punjab, Pakistan. Patients and Methods: Data of all new children undergoing detailed echocardiography was reviewed for type of lesion, age at presentation and gender. Results: Over a period of five years, (May 1996 to April 2001), 7400 patients underwent echocardiography. Of these, 6620 had cardiac lesions while 780 patients were normal and excluded from the study. Of 6620 patients, 4184 (63.2%) had congenital heart defects (CHD) while 2335 (35.3%) acquired heart disease (AHD) and 101 (1.5%) were placed in miscellaneous group. Of CHD, ventricular septal defect was the most common lesion (32% of all patients with CHD), followed by atrial septal defects (13.2%) and persistent arterial duct (12.8%). Majority was males (65%) and the mean age of presentation was 5.8 years for acyanotic and 4.8 years for cyanotic heart defects. Tetralogy of Fallot was the most common cyanotic lesion (16.06%) with mean age of presentation being 4.2 years. The relative incidence of patients with critical heart lesions was much less and only 586 patients (14%) were under the age of one year at presentation. Children presenting less than one month of age were only 3% (127 patients). Amongst AHD, 71.5% (1670) had rheumatic heart disease (RHD) while 24.5% (572) had myocardial disease, clinically diagnosed as myocarditis or dilated cardiomyopathy. The mean age of presentation for myocarditis was 2.3 years and majority was clustered in the months of March, April, September and October. Amongst RH D, mitral regurgitation was the commonest lesion; 681 patients (40.8%), followed by mixed lesion of mitral and aortic regurgitation in 382 patients (22%) and mitral stenosis in 264 patients (15.8%). Conclusion: Acquired heart diseases, in particular rheumatic heart disease continues to be an important cause of suffering among children in this part of the world. Myocardial diseases especially myocarditis is also common and has a seasonal variation indicating possible viral etiology.

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