Skip to main content
PMC home page
Clinical Cardiology logoLink to Clinical Cardiology
. 2006 Dec 5;27(4):236–240. doi: 10.1002/clc.4960270413

Patterns of congenital heart disease in unoperated adults: A 20‐year experience in a developing country

Hwaida Hannoush 1, Hala Tamim 2, Hussein Younes 1, Samir Arnaout 1, Walid Gharzeddine 1, Habib Dakik 1, Mounir Obeid 3, Fadi F Bitar 4,✉
PMCID: PMC6653966  PMID: 15119701

Abstract

Background: The number of patients with congenital cardiac disease reaching adulthood is increasing steadily. Many adults with such disease face both medical and surgical difficulties.

Hypothesis: This retrospective study was undertaken to assess the frequency and outcome of congenital heart disease (CHD) in unoperated adults.

Methods: The charts of all patients with unoperated CHD, who were admitted to a tertiary care center in Beirut, Lebanon, between 1980 and 2000 were reviewed. Of these, 206 patients (52% men, age at admittance 18–71 years [32.8 ± 13.3 years]) with a diagnosis of CHD were evaluated. Atrial septal defect (ASD) was the most common cardiac malformation with a relative frequency of 53%, followed by ventricular septal defects (11%), tetralogy of Fallot (11%), aortic anomalies (7%), pulmonary stenosis (6%), and Ebstein anomaly (4%). Most patients were symptomatic upon presentation, with dyspnea on exertion being the most common presenting symptom. Twenty‐seven patients (13%) had cyanotic CHD. Of 179 acyanotic patients, 113 (63%), and 17 of 27 cyanotic patients (63%) underwent surgical intervention. In‐hospital surgical complications for the acyanotic group included cerebrovascu‐lar accident (2%) and heart block (1%). Total surgical mortality was 4 of 130 (3%). One patient with tetralogy of Fallot presented with endocarditis and died.

Conclusion: Atrial septal defect is the most common defect reported in our experience; however, it occurs more frequently than that reported in the literature. Although most patients were symptomatic on presentation, their functional status was stable. Accordingly, their hospital course, whether managed medically or surgically, held a relatively low complication rate. This could be attributed to the uncomplicated nature of pathologies in our series. The surgical mortality and in‐hospital complications were slighter higher than those reported for similar lesions if repaired during childhood. This study reflects the relative frequency of various cardiac malformations in selected patients with “grown up” congenital heart disease (GUCH) and their natural survival pattern.

Keywords: congenital heart disease, adults, developing country, grown up congenital heart

Full Text

The Full Text of this article is available as a PDF (32.5 KB).

References

  • 1. Wren C, O'Sullivan JJ: Survival with congenital heart disease and need for follow up in adult life. Heart 2001; 85 (4): 438–443 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2. Gillum RF: Epidemiology of congenital heart disease in the United States. Am Heart J 1994; 127: 919–927 [DOI] [PubMed] [Google Scholar]
  • 3. Ferencz C: On the birth prevalence of congenital heart disease. J Am Coll Cardiol 1990; 16: 1701–1702 [DOI] [PubMed] [Google Scholar]
  • 4. Fyler DC: Prevalence In Nadas' Pediatric Cardiology, p. 273–280. Philadelphia: Hanley and Belfus, Inc., 1992. [Google Scholar]
  • 5. Hoffman JI: Incidence of congenital heart disease. Postnatal incidence. Pediatr Cardiol 1995; 16: 103–113 [DOI] [PubMed] [Google Scholar]
  • 6. Ferencz C, Rubin JD, McCarter RJ, Neill CA, Perry LW, Herper SI, Downing JW: Congenital heart disease: Prevalence at live birth. Am J Epidemiol 1985; 121: 31–36 [DOI] [PubMed] [Google Scholar]
  • 7. Campell M: Natural history of atrial septal defect. Br Heart J 1970; 32: 820–826 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8. Craig RJ, Selzer A: Natural history and prognosis of atrial septal defect. Circulation 1968; 37: 805–815 [DOI] [PubMed] [Google Scholar]
  • 9. Mark H, Young D: Congenital heart disease in the adult. Am J Cardiol 1965; 15: 293–302 [DOI] [PubMed] [Google Scholar]
  • 10. Child JS, Perloff JK: Natural survival patterns In Congenital Heart Disease in Adults (Eds. Perloff JK, Child JS.), p. 21 Philadelphia: W. B. Saunders, 1991. [Google Scholar]
  • 11. Perloff JK: The Clinical Recognition of Heart Disease, Ed 3 Philadelphia: W. B. Saunders, 1987. [Google Scholar]
  • 12. Ckolbel F, Hlavacek K, Kamenik L, Vanecek T Jr, Popelova J: Congenital heart defects in adults worldwide and in the Czeck Republic. Cas lek cesk 1993. 11;132: 557–579 [PubMed] [Google Scholar]
  • 13. Lien WP, Chen JJ, Chen JH, Lin JL, Hsieh YY, Wu TL, Chu SH, Hung CR: Frequency of various congenital heart diseases in Chinese adults: Analysis of 926 consecutive patients over 13 years of age. Am J Cardiol 1986; 57: 840–844 [DOI] [PubMed] [Google Scholar]
  • 14. Abraham KA, Cherian G, Rao VD, Sukumar IP, Krishnaswa S, John S: Tetralogy of Fallot in adults: A report on 147 patients. Am J Med 1979; 66: 811–816 [DOI] [PubMed] [Google Scholar]
  • 15. Bertranou EG, Blackstone EH, Hazelrig JB, Turner ME, Kirklin JW: Life expectancy without surgery in tetralogy of Fallot. Am J Cardiol 1978; 42: 458–466 [DOI] [PubMed] [Google Scholar]
  • 16. Teoh KH, Weisel RD, Ivanov J, Slattery SA: Survival and valve failure after aortic valve replacement. Ann Thorac Surg 1991; 52: 270–275 [DOI] [PubMed] [Google Scholar]
  • 17. Redington A: Congenital Heart Disease in Adults: A Practical Guide, Ed 1 Philadelphia: W. B. Saunders, 1994. [Google Scholar]
  • 18. Hu DCK, Seward JB, Puga FJ, Fuster V, Tajik AJ: Total correction of tetralogy of Fallot at age 40 years and older: Long‐ term follow‐up. J Am Coll Cardiol 1985; 5: 40–44 [DOI] [PubMed] [Google Scholar]
  • 19. Presbitero P, DeMarie D, Aruta E, Villani M, Disumma M, Ottino GM, Orzan F, Fubini A, Spinnler MT, Conte MR: Results of total correction of tetralogy of Fallot performed in adults. Ann Thorac Surg 1988; 46: 297–301 [DOI] [PubMed] [Google Scholar]
  • 20. Kirklin JW, Barratt‐Boyes BG. (Eds.): Cardiac Surgery, p. 463–497. New York: Wiley, 1986. [Google Scholar]
  • 21. Abe T, Kamata K, Taguchi A, Sugimoto S, Kawashima T, Inoue S, Nak‐anishi K, Takahash N, Morikawa M, Sasaki A: Surgical treatment and long‐term results of congenital heart disease in adults; early and late follow‐up studies in 231 cases. Rinsho Kyobu Geka 1994; 14: 224–234 [PubMed] [Google Scholar]
  • 22. Dore A, Glancy DL, Stone S, Menashe VD, Somerville J: Cardiac surgery for grown‐up congenital heart patients: Survey of 307 consecutive operations from 1991 to 1994. Am J Cardiol 1997; 80: 906–913 [DOI] [PubMed] [Google Scholar]
  • 23. Ammash N, Warnes CA: Cerebrovascular events in adult patients with cyanotic congenital heart disease. J Am Coll Cardiol 1996; 28: 768–772 [DOI] [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES