Chapter 2
INCIDENCE OF CONGENITAL HEART DISEASE (As noted by A.S. Nadas in his Pediatric Cardiology book published in 1957, in over a total of 3,780 heart malformations cases.)| VSD | 19.9 % | | PDA | 12.3 % | | ASD | 10.0 % | | Fallot | 14.5 % | | Transp. | 3.9 % | | Pulmonary stenosis | 11.9 % | | Coarct. | 4.9 % | | Others | 22.6 % |
BASIC ORIENTATION TO THE PROBLEM Congenital heart diseases are due to developmental abnormalities in the first 6 to 8 weeks of the fetal life, when the cardiovascular apparatus is formed.
The manifestations in terms of symptoms and clinical signs may appear at birth, later in childhood and some other times in adult life.
The congenital cardiac malformations are particularly important due to the alterations in the hemodynamic patterns of the fetal circulation, at birth, childhood and if the patient survives, at adulthood.
The incidence of heart malformation is in the range of 9 to 12 per 1,000 live births.
In the search of proper diagnosis, a good physical examination is the most essential aspect in the study of these diseases. With the help of the electrocardiogram, chest roentgenograms and phonocardiogram a proper diagnosis is possible in most patients.
In every case not only the possible anatomical defect is to be considered, but what is essential is establishing the stage of the disease and functional deficit in every patient.
If a higher degree of accuracy is to be achieved invasive techniques are necessary and cardiac catheterization and selective angiography can not, so far, be replaced on assessing cardiac structures and on the hemodynamic analysis of pressures, flow and resistances.
Echocardiography, indirect pressure tracings and systolic time intervals are complementary studies which can provide valuable information in many cases.
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