Congenital heart disease in south-west Saudi Arabia.

C heart disease (CHD) constitutes the majority of pediatric heart diseases and remains one of the major causes of morbidity and mortality. Previous studies demonstrated that CHD worldwide, is relatively common with a prevalence ranging from 4-50 per 1000 live births.1 The prevalence was 10.7 per 1000 in KSA2 in 2001, and 17.5 per 1000 in Central Australia3 in 2004. Only a few studies in Saudi Arabia have been reported. The prevalence of CHD varies from study to study due to trivial defects included or excluded. Knowledge of the epidemiology of pediatric heart diseases is important for assessment of the magnitude of the problem, for prevention, diagnosis, management, and future plans. There is limited information on the magnitude of the pediatric heart disease problem in Albaha, Kingdom of Saudi Arabia. The aim of this study is to demonstrate the magnitude of CHD in Albaha, the current situation of the pediatric heart disease service, the obstacles in the service, and future expectations. This is hospital based, cross sectional study, included follow up and new cases referred to the Pediatric Cardiology Unit, King Fahad Hospital Albaha, Kingdom of Saudi Arabia from April 2005 to 2010. All patients were aged between birth and 12 years old. The work was approved by the ethical committee of the hospital. A computer based software program was established to register all children screened in the study. All referred patients were examined clinically, underwent chest x-ray, and electrocardiogram. The diagnosis of all patients was confirmed by echocardiography (Philips IE33 echocardiography machine, Philips, Bothel, WA, USA). For sedation, oral Chloral Hydrate 50 mg/kg body weight was used. The echocardiography examination was conducted using M-mode, colored 2-dimensional, pulse, and continuous wave Doppler echocardiogram. Two-dimensional echocardiographic pictures were recorded in the standard parasternal long axis, short axis, apical 4 chamber, subcostal and suprasternal views. The presence and severity of any cardiac defect were analyzed using the American Society of Echocardiography guidelines. Congenital heart disease was defined as a structural abnormality of the heart or intrathoracic great vessels that is actually or potentially of functional significance. Therefore, the following conditions were excluded; patent ductus arteriosus (PDA) in premature newborns (one month of age), patent foramen ovale, bicuspid aortic valve without stenosis, persistent left superior vena cava and right sided aortic arch, trivial mitral regurgitation (MR), trivial tricuspid regurgitation (TR). Patients with suspected Kawasaki disease without cardiac impairment, children with thalassemia and other hematology problems, rheumatic heart disease, and other acquired heart diseases were also excluded. Patients with cardiac murmur with structurally and functionally normal hearts were excluded and grouped separately. Congenital heart disease was subdivided into cyanotic and acyanotic heart diseases. A total of 2610 children were screened in the study, 400 patients as follow up cases diagnosed before 2005, while 2210 children were new cases screened within the study period in our pediatric cardiology unit due to cardiac murmur by clinical examination. Five hundred and thirty children had normal echocardiography, 500 cases were preterm with PDA, and 480 cases were with patent foramen ovale. Seven hundred patients (31.8%) of these new cases were diagnosed with heart disease, 591 (26.8%) of them were found to have CHD. The most frequent type of CHD are shown in Table 1 and were, double outlet right ventricle in 10 patients (1.7%), pulmonary regurgitation 7