(*Senior Resident, **Assistant Professor) Spectrum of congenital heart diseases in Meghalaya –A Hospital based study Sourabh Gohain Duwarah*. Dhrubajyoti Sharma*, Rashna Dass**, Ajit Chhetri**, Pankaj Jain*, Bhaskar Saikia*, Himesh Barman*, (*Senior Resident, **Assistant Professor) Department of Pediatric Disciplines, North Eastern Indira Gandhi Regional Institute of Health and Medical Science (NEIGRIHMS), Shillong.

Introduction Congenital heart disease (CHD) refers to structural or functional heart disease that is present at birth even if it is discovered much later CHD: Occurs in approximately 8/1000 live births. No available data on prevalence of CHD from Meghalaya

Aims and objectives The present study was conducted to ascertain the spectrum of Congenital heart disease in Meghalaya (0 to 18 years old).

Material and methods Study design: Retrospective study from Jan’05 to June’07 (2.5 years). Place of study: Dept. of Pediatric Disciplines,NEIGRIHMS,Shillong. Age group: 0 to 18 years of age. Data on congenital heart diseases were collected in semi structured proforma and analysed. The source of information was all outpatient and inpatient records including echocardiography records from Jan’05 to June’07 Exclusion criteria included CHDs with associated syndromes, since the present study was to know the prevalence of isolated CHDs in Meghalaya.

Results and observations Total no of cases seen during study period: 12,322. Congenital heart disease: 286(2.32%).

Results- No. of referred cases Thirty two percent(32%)cases were referred cases.

Results- Distribution of cases during the study period Cases increased from 9.79% in Jan-June’05 to 31.81% in Jan-June’07.

Results- age wise distribution Maximum cases were diagnosed during infancy(26.92%) followed by second year(13.28%) of life.

Results – various CHDs observed in the present study 1(0.35) 1(100) TA Results – various CHDs observed in the present study Congenital heart disease (CHD) Total no of cases Percentage(%) Ventricular septal defect (VSD) 136 47.55 Atrial septal defect (ASD) 67 23.52 Patent ductus arteriosus (PDA) 37 12.93 Tetralogy of fallot (TOF) 23 8.04 Pulmonary stenosis (PS) 7 2.44 Endocardial cushion defect (ECD) 4 1.39

Results-various CHDs observed in the present study Total no of cases Percent(%) Aortic stenosis (AS) 3 1.04 Bicuspid aortic valve (BAV) 2 0.6 Complex CHD (cyanotic) Coarctaion of aorta (CoA) 1 0.35 Double outlet right ventricle (DORV) Transposition of great arteries (TGA) PDA with AS Tricuspid atresia (TA)

Results- sex wise prevalence of CHD The present study shows that, 131(46%) male and 155(54%) female children had CHD.

Results– sex wise distribution VSD ASD PDA TOF PS ECD AS Others Male 63(46.32) 29(43.28) 13(35.13) 13(56.52) 3(42.85) 2(50) 3(100) 5(3.81) Female 73(53.67) 38(56.71) 24(64.86) 10(43.47) 4(57.14) 4(2.58)

Results-prevalence of acyanotic CHD Among the acyanotic CHDs most common was VSD(53%) followed by ASD(26%) and PDA(14%).

Results- prevalence of cyanotic CHD Among the cyanotic group most common was TOF(81%).

Prevalence of major types CHDs in the available literature & its comparison to the present study Place VSD(%) ASD(%) PDA(%) TOF(%) Present study 47.5 23.5 12.9 8 India (1971) 29 12 11 17 UK (1981) 32.5 5.9 11.9 USA (1990) 32.1 7.4 8.3 3.8 Japan (1990) 60 5.3 3.6 5.8 Egypt (2000) 35.3 13.6 6.1 5 S.Arabia (2001) 39.5 11.5 8.6 4.2

Comparision of prevalence of CHD in the present study with studies in south India and Punjab. 2.32% 2.50% 3% 0.00% 0.50% 1.00% 1.50% 2.00% 3.00% 3.50% Present study South India Punjab Analysis revealed a prevalence of CHD 2.32%. Analysis revealed a prevalence of CHD 2.32% which was not as high as other parts of the country.

Comparison of the prevalence of major CHDs in different studies in India. Name of the CHD Present study (n=286) (Jan’05-June’07) Study by Smitha R et al in mysore (n=500) (2000-2004) Study by L.Kasturi et al in Mumbai (n=108) VSD 136(47.55) 242(40.47) 29(27) ASD 67(23.52) 114(19.06) 26(24) PDA 37(12.93) 57(9.53) 7(6) TOF 23(8.04) 80(13.38) 10(9)

Discussion contd… The frequency of rare types of CHDs like AS,PS, TGA,TA,ECD were less in the present study. Most of the CHDs were diagnosed during infancy(26.92%) which was in accordance with the other studies. Prevalence was slightly higher in females as compared to the males.

Discussion contd… The prevalence of CHDs in the study was increasing from 2005 to 2007 (9.79% in Jan-June’05 to 31.81% in Jan-June’07). Increasing number of OPD visits, improvement of diagnosis, attention or awareness among the referring government / private sector doctors might be the causes for the increase.

Conclusion The present findings indicate that, (a) Prevalence of CHDs in Meghalaya is not as high as the prevalence reported by other Indian studies. (b) However, it is an important disease which requires immediate attention and highlights the need for appropriate cardio-thoracic surgical services accessible to the common man in this region .

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