Congenital Heart Defects in Children with Upper Gastrointestinal Anomalies

Document Type : Original Article

Authors

1 Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Pediatrics, Mashhad university of Medical Sciences, Mashhad, Iran

3 Mashhad Universi of Medical sciences, Mashhad, Iran

4 Akbar Clinical Research and Development Unit, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Background: Congenital heart defect (CHD) is one of the leading causes of neonatal death. Although the majority of CHDs are isolated, a significant number of them are associated with noncardiac anomalies. Esophageal Atresia (EA)/ Tracheoesophageal Fistula (TEF) is the most common congenital disorder of the upper GI tract. It is estimated that up to 70% of EA/TEF infants have other associated congenital anomalies such as CHD. This study determined the proportion of heart anomalies among the diseases of the upper GI tract in Imam Reza Hospital of Mashhad.
Methods: The records of 38 infants with upper GI obstruction who were referred to the Pediatric Cardiology Clinic of Imam Reza Hospital in Mashhad between 2001 and 2017 were evaluated in this retrospective study. Data were coded and entered into SPSS software (version 16) and analyzed using Chi-square and T-test.
Results: In this study, 38 babies with upper GI obstruction were evaluated (20 patients were female, 52.6%), and the average birth weight was 2.390 +-0.870 gr. Among the parents, 13 patients (34.2%) were relative (third-degree or more) and 25 patients (65.8%) were nonrelative. The initial and final diagnosis was different at 14 pt (36.8%) that was confirmed with echocardiographic findings. CHDs were divided into two groups in this study. Malformations such as PFO (patent foramen ovale) or FMV without MR (floppy mitral valve without mitral regurgitation) considered as non-important congenital heart diseases. Other malformations that require interventional or medical management such as VSD, ASD, TOF, or other CHDs are considered important CHDs.  Nineteen pt (50%) had important CHD and 16 pt (42.1%) had non-important CHD  and 3 pt (7.9%) had normal echocardiographic findings.
Conclusion: The heart defect is the most common associated anomaly in children with EA/TEF, which is divided into two subgroups. The first important one is CHD, which is effective in gastric surgery and management, and VSD is the most common type. The other group is non important CHD such as PFO or FMV without MR that are not effective in their management. The patients with EA/TEF are at risk for low birth weight and preterm delivery.
 
 

Keywords

References

  1. Gilboa SM, Salemi JL, Nembhard WN, Fixler DE, Correa A. Mortality resulting from congenital heart disease among children and adults in the United States, 1999 to 2006. Circulation. 2010; 122(22):
    2254-63.
  1. Kliegman RM, Stanton BM, Geme JS, Schor NF. Nelson textbook of pediatrics. 21st ed. New York: Elsevier Health Sciences; 2020.
  2. Hoffman JI, Michell SC. The incidence of congenital heart disease. J Am Coll Cardiol. 2002; 39(12):
    1890-900.
  3. German JC, Mahour GH, Woolley MM. Esophageal atresia and associated anomalies. J Pediatr Surg. 1976; 11(3):299-306.
  4. Mohsenzadeh A, Saket S, Ahmadipour S, Baharvand B. Prevalence and types of congenital heart disease in babies born in the city of Khorramabad (2007-2011). Yafteh. 2014; 15(5):23-9.
  5. Mohsenzadeh A, Saket S, Ahmadipour S, Baharvand B. Prevalence and types of congenital heart disease in babies born in the city of Khorramabad (2007-2011). Yafteh. 2014; 15(5):23-9.
  6. Jenkins KJ, Correa A, Feinstein JA, Botto L, Britt AE, Daniels SR, et al. Noninherited risk factors and congenital cardiovascular defects: current knowledge: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young: endorsed by the American Academy of Pediatrics. Circulation. 2007; 115(23):2995-3014.
  7. Strauss A, Toth B, Schwab B, Fuchshuber S, Schulze A, Netz H, et al. Prenatal diagnosis of congenital heart disease and neonatal outcome--a six years experience. Eur J Med Res. 2001; 6(2):66-70.
  8. Verheugt CL, Uiterwaal CS, Grobbee DE, Mulder BJ. Long-term prognosis of congenital heart defects: a systematic review. Int J Cardiol. 2008; 131(1):25-32.
  9. Ein SH, Shandling B, Wesson D, Filler RM. Esophageal atresia with distal tracheoesophageal fistula: associated anomalies and prognosis in the 1980s. J Pediatr Surg. 1989; 24(10):1055-9.
  10. Hassink EA, Rieu PN, Hamel BC, Severijnen RS, Vd Staak FH, Festen C. Additional congenital defects in anorectal malformations. Eur J Pediatr. 1996; 155(6):477-82.
  11. Olgun H, Karacan M, Caner I, Oral A, Ceviz N. Congenital cardiac malformations in neonates with apparently isolated gastrointestinal malformations. Pediatr Int. 2009; 51(2):260-2.
  12. Wojtalik M, Mrówczyński W, Henschke J, Wronecki K, Siwińska A, Piaszczyński M, et al. Congenital heart defect with associated malformations in children. J Pediatr Surg. 2005; 40(11):1675-80.
  13. Thompson AJ, Mulholland HC. The incidence of cardiac lesions in infants born with major gastrointestinal malformations in Northern Ireland. Ulster Med J. 2000; 69(1):23-6.
  14. Tulloh RM, Tansey SP, Parashar K, De Giovanni JV, Wright JG, Silove ED. Echocardiographic screening in neonates undergoing surgery for selected gastrointestinal malformations. Arch Dis Child Fetal Neonatal Ed. 1994; 70(3): F206-8.
  15. Fyler DC, Dc F, We H, He C. Report of the New England regional infant cardiac program. Pediatrics. 1980; 65(2):377-461.
  16. Rosenthal A. Congenital cardiac anomalies and gastrointestinal malformations. The genetics of cardiovascular disease. Boston, MA: Springer; 1987. P. 113-26.
  17. Kumar A, Singh K. Major congenital malformations of the gastrointestinal tract among the newborns in one of the English Caribbean Countries, 1993-2012. J Clin Neonatol. 2014; 3(4):205.
  18. Lin AE, Pober BR, Adatia I. Congenital diaphragmatic hernia and associated cardiovascular malformations: type, frequency, and impact on management. Am J Med Genet Part C Semin Med Genet. 2007; 145C(2):201-16.
  19. Hashemizadeh H, Boroumand H, Hirafard M. Investigating the prevalence of congenital heart disease in imperforate anus infants referred to pediatric surgery department of Dr. Sheikh hospital in Mashhad Iran. Iran J Obstet Gynecol Infertil. 2012; 15(27):21-7.
  20. Kouwenberg M, Severijnen RS, Kapusta L. Congenital cardiovascular defects in children with intestinal malrotation. Pediatr Surg Int. 2008; 24(3):257-63.
  21. Feenstra B, Gørtz S, Lund M, Ranthe MF, Geller F, Melbye M. Co-occurrence of infantile hypertrophic pyloric stenosis and congenital heart defects: a nationwide cohort study. Pediatr Res. 2019; 85(7):955-60.
  22. Tuo G, Pini Prato A, Derchi M, Mosconi M, Mattioli G, Marasini M. Hirschsprung’s disease and associated congenital heart defects: a prospective observational study from a single institution. Front Pediatr. 2014; 2:99.
  23. Fattouh AM, Mogahed EA, Hamid NA, Sobhy R, Saber N, El-Karaksy H. The prevalence of congenital heart defects in infants with cholestatic disorders of infancy: a single-center study. Arch Dis Child. 2016; 101(9):803-7.
  24. Uğuralp S, Paç FA, Gürbüz N, Demircan M. Congenital heart disease associated with gastrointestinal system malformations in the newborn: is it sufficiently evaluated? J Inonu Univ Med Facul. 2002; 9(4):229-32.
  25. Gokhroo RK, Gupta S, Arora G, Bisht DS, Padmanabhan D, Soni V. Prevalence of congenital heart disease in patients undergoing surgery for major gastrointestinal malformations: an Indian study. Heart Asia. 2015; 7(1):29-31.
  26. Chéhab G, Fakhoury H, Saliba Z, Issa Z, Faour Y, Hammoud D, et al. Congenital heart disease associated with gastrointestinal malformations. J Med Liban. 2007; 55(2):70-4.
  27. Orun UA, Bilici M, Demirçeken FG, Tosun M, Ocal B, Cavusoglu YH, et al. Gastrointestinal system malformations in children are associated with congenital heart defects. Anadolu Kardiyol Derg. 2011; 11(2):146-9.
  28. Abbag FI. Congenital heart diseases and other major anomalies in patients with Down syndrome. Saudi Med J. 2006; 27(2):219-22.
  29. Colombo JN, McCulloch MA. Acyanotic congenital heart disease: left-to-right shunt lesions. Neo Reviews. 2018; 19(7):e375-83.
  30. Marino B. Congenital heart disease in patients with Down's syndrome: anatomic and genetic aspects. Biomed Pharmacother. 1993; 47(5):197-200.
  31. Prasad C, Chudley AE. Genetics and cardiac anomalies: the heart of the matter. Indian J Pediatr. 2002; 69(4):321-32.
  32. Cho S, Moore SP, Fangman T. One hundred three consecutive patients with anorectal malformations and their associated anomalies. Arch Pediatr Adolesc Med. 2001; 155(5):587-91.
  33. David TJ, O'Callaghan SE. Cardiovascular malformations and oesophageal atresia. Br Heart J. 1974; 36(6):559-65.
  34. Yigiter M, Yildiz A, Firinci B, Yalcin O, Oral A, Salman AB. Annular pancreas in children: a decade of experience. Eurasian J Med. 2010; 42(3):116-9.
  35. Khalesi N, Taghipour R, Aflatoonian M. A case report of cerebral nocardiosis in a patient with Crohn's disease. Razi J Med Sci. 2010; 16:40-63.
  36. Leonard H, Barrett AM, Scott JE, Wren C. The influence of congenital heart disease on survival of infants with oesophageal atresia. Arch Dis Child Fetal Neonatal Ed. 2001; 85(3): F204-6.

38. Mery CM, De León LE, Rodriguez JR, Nieto RM, Zhang W, Adachi I, et al. Effect of gastrointestinal malformations on the outcomes of patients with congenital heart disease. Ann Thorac Surg. 2017; 104(5):1590-6.

Iranian Journal of Neonatology
Volume 12, Issue 4
October 2021
Pages 54-58

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