Nkoke Clovis, Balti Eric, Menanga Alain, Dzudie Anastase, Lekoubou Alain, Kingue Samuel, Kengne Andre Pascal
Faculty of Medicine and Biomedical Sciences, Department of Internal Medicine, University of Yaounde 1, Yaounde, Cameroon.
Faculty of Medicine and Pharmacy, Brussels Free University-VUB, Brussels, Belgium.
Transl Pediatr. 2017 Jan;6(1):40-45. doi: 10.21037/tp.2016.11.01.
Congenital heart disease (CHD) is a common condition in children in Sub-Saharan Africa (SSA), where it is associated with poor outcomes. Diagnosis of CHD in SSA depends essentially on echocardiography, which is available only in few urban referral centers. Our aim was to assess time changes in the pattern of referral for pediatric echocardiography and the subsequent diagnosis of structural CHD in a major SSA city.
All pediatric echocardiography performed between 2004 and 2013 at the echocardiography laboratory of the Yaounde General Hospital were reviewed. The primary indication of the study and the presence of structural CHD were recorded.
Between 2004 and 2013, 9,390 echocardiograms were performed and 834 (8.9%) children aged 1 day to 15 years underwent echocardiography at the center, and 227 (27.2%) cases of definite structural CHD were diagnosed, with 123 (54.2%) in boys. The most frequent indications for echocardiography were heart murmurs (40%) and the suspicion of CHD (37.4%). The commonest CHD was ventricular septal defect (VSD) (30%) with tetralogy of Fallot being the most frequent cyanotic heart lesion (5.3%). The proportion of pediatric echocardiography decreased from 13.3% in 2004-2005 to 6.1% in 2012-2013 (P=0.001) but not in a linear fashion (P=0.072 for linear trend).The diagnosis of structural CHD increased from 25.1% in 2004-2005 to 27.1% in 2012-2013. This increase however was non-significant (P=0.523) and did not follow a linear trend (P=0.230).
The pattern of referral for pediatric echocardiography at this center has changed over time, but diagnosis of structural CHD has remained the same. Improving access to this diagnostic procedure and subsequent treatment of diagnosed CHD will help improving the outcome of the disease in this setting.
先天性心脏病（CHD）在撒哈拉以南非洲（SSA）儿童中是一种常见病症，在该地区其预后较差。SSA地区CHD的诊断主要依赖超声心动图检查，而这仅在少数城市转诊中心可进行。我们的目的是评估SSA一个主要城市中儿科超声心动图转诊模式的时间变化以及随后结构性CHD的诊断情况。
回顾了2004年至2013年期间雅温得综合医院超声心动图实验室进行的所有儿科超声心动图检查。记录研究的主要指征以及结构性CHD的存在情况。
2004年至2013年期间，共进行了9390次超声心动图检查，834名年龄在1天至15岁的儿童在该中心接受了超声心动图检查，确诊结构性CHD的有227例（27.2%），其中男孩123例（54.2%）。超声心动图检查最常见的指征是心脏杂音（40%）和疑似CHD（37.4%）。最常见的CHD是室间隔缺损（VSD）（30%），法洛四联症是最常见的青紫型心脏病变（5.3%）。儿科超声心动图检查的比例从2004 - 2005年的13.3%降至2012 - 2013年的6.1%（P = 0.001），但并非呈线性下降（线性趋势P = 0.072）。结构性CHD的诊断率从2004 - 2005年的25.1%升至2012 - 2013年的27.1%。然而，这一增长并不显著（P = 0.523），也未呈线性趋势（P = 0.230）。
该中心儿科超声心动图的转诊模式随时间发生了变化，但结构性CHD的诊断情况保持不变。改善获得这种诊断程序的机会以及对确诊CHD的后续治疗将有助于改善该地区此病的预后。
