Skip to main content
×
Home
    • Aa
    • Aa

Detection rates of congenital heart disease in Guatemala

  • Sara M. Trucco (a1), Joaquin Barnoya (a2) (a3), Luis Alesandro Larrazabal (a1), Aldo Castañeda (a2) and David F. Teitel (a1)...
Abstract
AbstractObjectives

In developing countries, congenital heart disease is often unrecognised, leading to serious morbidity and mortality. Guatemala is one of the few developing countries where expert paediatric cardiac treatment is available and affordable, and therefore early detection could significantly improve outcome. We assessed regional congenital heart disease detection rates in Guatemala, and determined whether they correlated with the regional human development index.

Methods

We retrospectively reviewed all new cardiac referrals made in 2006 to the Unidad de Cirugia Cardiovascular Pediatrica, the only paediatric cardiac centre in Guatemala. We calculated regional detection rates by comparing the number of congenital heart disease referrals with the expected incidence using the National Ministry of Health birth data. We then compared the regional detection rates with the human development index data published in the United Nations 2006 Development Program Report using Spearman’s rank correlation.

Results

An estimated 3935 infants with cardiac defects were born in Guatemala in 2006, an expected 1380 (35%) of whom had severe forms. Overall, only 533 children (14%) with cardiac defects were referred. Of these, 62% had simple shunt lesions, 13% had cyanotic lesions, and 10% had left-sided obstructive lesions. Only 11.5% of referred patients were neonates. Regional detection rates, ranged 3.2–34%, correlated with the regional human development index (r = 0.75, p < 0.0001).

Conclusions

Current detection of congenital heart disease in Guatemala is low and correlates with the regional human development index. Those detected are older and have less severe forms, suggesting a high mortality rate among Guatemalan neonates with complex cardiac defects.

Copyright
Corresponding author
Correspondence to: S. M. Trucco, MD, Pediatric Cardiology, University of California, San Francisco, 505 Parnassus Avenue, PO Box 0544, San Francisco, California 94143, United States of America. Tel: 415 353 4141; Fax: 415 353 4144; E-mail: smtrucco@gmail.com
References
Hide All
1. Gillum RF. Epidemiology of congenital heart disease in the United States. Am Heart J 1994; 127: 919927.
2. Gembruch U. Prenatal diagnosis of congenital heart disease. Prenat Diagn 1997; 17: 12831298.
3. Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 18901900.
4. Marelli AJ, Mackie AS, Ionescu-Ittu R, Rahme E, Pilote L. Congenital heart disease in the general population: changing prevalence and age distribution. Circulation 2007; 115: 163172.
5. Kuehl KS, Loffredo CA, Ferencz C. Failure to diagnose congenital heart disease in infancy. Pediatrics 1999; 103: 743747.
6. Yacoub MH. Establishing pediatric cardiovascular services in the developing world: a wake-up call. Circulation 2007; 116: 18761878.
7. Larrazabal LA, Jenkins KJ, Gauvreau K, et al. Improvement in congenital heart surgery in a developing country: the Guatemalan experience. Circulation 2007; 116: 18821887.
8. Stolf NA. Congenital heart surgery in a developing country: a few men for a great challenge. Circulation 2007; 116: 18741875.
9. Donald C. Fyler. Report of the New England Regional Infant Cardiac Program. Pediatrics 1980; 65: 375461.
10.United Nations Development Programme. Human development report 2006. Palgrave Macmillan, Published for the United Nations Development Programme. Basingstoke, New York, 2006.
11. Lee KS, Park SC, Khoshnood B, Hsieh HL, Mittendorf R. Human development index as a predictor of infant and maternal mortality rates. J Pediatr 1997; 131: 430433.
12. Sharma SD. Making the Human Development Index (HDI) gender-sensitive. Gend Dev 1997; 5: 6061.
13. Porter JR, Purser CW. Measuring relative sub-national human development: an application of the United Nation’s human development index in the U.S. J Econ Soc Meas 2008; 33: 253269.
14. Cifuentes M, Sembajwe G, Tak S, Gore R, Kriebel D, Punnett L. The association of major depressive episodes with income inequality and the human development index. Soc Sci Med 2008; 67: 529539.
15. Shah A. The relationship between elderly suicide rates and the human development index: a cross-national study of secondary data from the World Health Organization and the United Nations. Int Psychogeriatr 2009; 21: 6977.
16. Jacinto-Rego SA, Bruch VL, Boscatto A, et al. The relationship between the human development index and nutritional variables in Brazilian children. Rev Salud Publica (Bogota) 2008; 10: 6270.
17. Gupta SK, Keck J, Ram PK, Crump JA, Miller MA, Mintz ED. Part III. Analysis of data gaps pertaining to enterotoxigenic Escherichia coli infections in low and medium human development index countries, 1984–2005. Epidemiol Infect 2008; 136: 721738.
18. Ram PK, Crump JA, Gupta SK, Miller MA, Mintz ED. Part II. Analysis of data gaps pertaining to Shigella infections in low and medium human development index countries, 1984–2005. Epidemiol Infect 2008; 136: 577603.
19. Crump JA, Ram PK, Gupta SK, Miller MA, Mintz ED. Part I. Analysis of data gaps pertaining to Salmonella enterica serotype Typhi infections in low and medium human development index countries, 1984–2005. Epidemiol Infect 2008; 136: 436448.
20. Hobdell MH, Lalloo R, Myburgh NG. The human development index and per capita gross national product as predictors of dental caries prevalence in industrialized and industrializing countries. Ann N Y Acad Sci 1999; 896: 329331.
21. Craig RJ, Selzer A. Natural history and prognosis of atrial septal defect. Circulation 1968; 37: 805815.
22. Coggin CJ, Parker KR, Keith JD. Natural history of isolated patent ductus arteriosus and the effect of surgical correction: twenty years’ experience at The Hospital for Sick Children, Toronto. Can Med Assoc J 1970; 102: 718720.
23. Minette MS, Sahn DJ. Ventricular septal defects. Circulation 2006; 114: 21902197.
24. Massin MM. Midterm results of the neonatal arterial switch operation. A review. J Cardiovasc Surg (Torino) 1999; 40: 517522.
25. Liebman J, Cullum L, Belloc NB. Natural history of transpositon of the great arteries. Anatomy and birth and death characteristics. Circulation 1969; 40: 237262.
26. Scott DJ, Rigby ML, Miller GA, Shinebourne EA. The presentation of symptomatic heart disease in infancy based on 10 years’ experience (1973–82). Implications for the provision of services. Br Heart J 1984; 52: 248257.
27. Hoffman JI, Kaplan S, Liberthson RR. Prevalence of congenital heart disease. Am Heart J 2004; 147: 425439.
28. Kowalsky RH, Newburger JW, Rand WM, Castaneda AR. Factors determining access to surgery for children with congenital cardiac disease in Guatemala, Central America. Cardiol Young 2006; 16: 385391.
29. Kovalchin JP, Silverman NH. The impact of fetal echocardiography. Pediatr Cardiol 2004; 25: 299306.
30. Franklin O, Burch M, Manning N, Sleeman K, Gould S, Archer N. Prenatal diagnosis of coarctation of the aorta improves survival and reduces morbidity. Heart 2002; 87: 6769.
31. Bonnet D, Coltri A, Butera G, et al. Detection of transposition of the great arteries in fetuses reduces neonatal morbidity and mortality. Circulation 1999; 99: 916918.
32. Tworetzky W, McElhinney DB, Reddy VM, Brook MM, Hanley FL, Silverman NH. Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome. Circulation 2001; 103: 12691273.
33. Talner CN. Report of the New England Regional Infant Cardiac Program, by Donald C. Fyler, MD, Pediatrics, 1980; 65(Suppl): 375–461. Pediatrics 1998; 102: 258–259.
34. Lien WP, Chen JJ, Chen JH, et al. Frequency of various congenital heart diseases in Chinese adults: analysis of 926 consecutive patients over 13 years of age. Am J Cardiol 1986; 57: 840844.
35. Hoffman JI. Incidence of congenital heart disease: I. Postnatal incidence. Pediatr Cardiol 1995; 16: 103113.
36. Guitti JC. Epidemiological characteristics of congenital heart diseases in Londrina, Parana south Brazil. Arq Bras Cardiol 2000; 74: 395404.
37. Mangones T, Manhas A, Visintainer P, Hunter-Grant C, Brumberg HL. Prevalence of congenital cardiovascular malformations varies by race and ethnicity. Int J Cardiol 2009.
38. Vida VL, Barnoya J, Larrazabal LA, Gaitan G, de Maria Garcia F, Castaneda AR. Congenital cardiac disease in children with Down’s syndrome in Guatemala. Cardiol Young 2005; 15: 286290.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
  • URL: /core/journals/cardiology-in-the-young
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Full text views

Total number of HTML views: 3
Total number of PDF views: 8 *
Loading metrics...

Abstract views

Total abstract views: 100 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 23rd October 2017. This data will be updated every 24 hours.