Gaps in Clinical Studies in Patients with Critical Congenital Heart Disease

Abstract

The purpose of this study was to assess the potential clinical examination in the early diagnosis of patients with CCHD.

Patients and Methods: Retrospectively were followed 272 newborns and infants up to 3 months of age with CCHD for 25 years (1987-2011) from the region of North-East Bulgaria. The cardiac malformations were divided into 3 groups: obstructive lesions of the systemic circulation (OLSC) – 103 children, obstructive lesions of the pulmonary circulation (OLPC) – 64 children and non-obstructive mixing cardiopathies (NMCP) – 105 children. It were analyzed the initial clinical symptoms, place and manner of the disease detection, the discharged neonates without established heart disease and those with placed wrong or incomplete primary diagnosis.

Results: The incidence of the CCHD was 12.5% of CHD. The mean time of the initial clinical manifestation was 3.45 days, which is shorter in newborns with OLPC – 1.8 days, and the longest is in OLSC – 4.5 days (p<0.05). In 44.4% initial clinical symptoms were established during the first day, and by day 4 – in 81.7%. Most often the first clinical symptom is cyanosis – 65%. In 21% of cases there was no significant murmur. The average age of diagnosis is 8.5 days and was significantly lower in OLPC – 4.2 days, compared to OLSC – 9.5 days and NMCP – 10 days (p<0.05). By day 4 were diagnosed 54% of CCHD and 27.7% of the infants with manifested initial symptoms (81.7%) remained without diagnosis. Usually the initial diagnosis is put in the children’s hospitals – 60% and only 30% in the neonatology units. Without established heart disease are discharged 15.8% of newborns, primarily with coarctation of the aorta, total anomalous pulmonary venous return and transposition of the great arteries. Initial diagnosis was incorrect in 22%.

Conclusion: The physical examination in newborn CCHD is unsatisfactory and the diagnosis is often delayed, especially in the cases of OLSC and same of NMCP. That is why screening programs are needed for early detection of these patients to improve their prognosis.