The clinical outcomes in children with cyanotic congenital heart diseases at Srinagarind hospital (2535 - 2545)

Abstract

Background: The incidence of cyanotic congenital heart diseases is about 18% of all patients with congenital heart defects and the major mortality occurred during infancy. Most infants even with complex congenital heart lesions now survive the neonatal period, prolonged hypoxemia may also adversely impact neurodevelopment and the outcome of later surgery.

Objective: To determine the outcome of medical and surgical treatment in this group of patients.

Design: Descriptive study.

Setting: Srinagarind hospital, Khon Kaen University.

Population and Samples: All patients age younger than 15 years with diagnosis of various cyanotic congenital heart diseases, which were treated between 1January 1992 and 31 December 2002

amounted to 1,106 cases.

Intervention: Medical treatment and/or cardiac surgery.

Measurements: Hospital and surgical mortality.

Results: A total of 1,106 patients with diagnosis of various cyanotic congenital heart diseases were included in this study. Cardiopathy types included: 537 tetralogy of Fallot,152 transposition of the great arteries, 94 double outlet right ventricle, 71 dextrocardia, 69 single atrium and/or single ventricle, 64 tricuspid atresia, 52 pulmonary atresia, 25 Ebstein’s anomaly of tricuspid valve, 21 truncus arteriosus, 13 total anomalous pulmonary venous return, and 8 hypoplastic left heart syndrome.  Total correction and palliative surgery were performed in 377 and 279, respectively. Among 123 patients who died in hospital, 77 died after cardiac surgery. Causes of death of the remaining 46 patients were anoxic spells, sepsis and brain abscesses.

Conclusions: Sixty percent of cyanotic congenital heart patients were repaired surgically. In 35%, the total correction and in 25% the palliative surgeries were performed. Average surgical mortality for all cyanotic congenital heart patients was 11.7%. Tetralogy of Fallot was the most common defects. Eighty four percent of them were underwent cardiac surgery with 9.1% surgical mortality. Complications after surgery were pleural effusion, hemothorax and chylothorax. The majority of cyanotic congenital heart diseases, even the more complex defects such as transposition of the great arteries, were now amenable to correction in Srinagarind hospital, although surgical mortality post arterial switch operation was high (25%). Some of the cyanotic patients were unable to repair,supportive treatment was still the good choice in this group.