Congenital heart disease at a tertiary care center in Lebanon

To study the epidemiology of congenital heart disease (CHD) at the American University of Beirut-Medical Center, we reviewed the medical records of all cardiac patients seen at our outpatient cardiology clinic (OPD) between 1980 and 1995. The charts of all patients with CHD seen as inpatients and/or outpatients at our center during the year 1995 were also reviewed. A cardiologist evaluated all patients and the diagnosis was confirmed at least by echocardiography. The frequency of CHD was reported among three groups: 1980-1995 OPD groups (Group A); the group with CHD seen during the year 1995 (Group B); and (Group C), a subgroup of group B, included all newborns with CHD born at our hospital during the year 1995. Stillbirth and premature infants with the diagnosis of patent ductus arteriosus were excluded from the study.

Group A included 883 patients. 344 patients were evaluated in Group B, with a mean age of 3.8 years. The incidence of CHD was 11.5/1,000 live births at our center. There was a relatively low prevalence of complex lesions (i.e., hypoplastic left heart syndrome, transposition of the great arteries) and a relatively high prevalence of the simpler cardiac malformation (i.e., ventricular and atrial septal defects, pulmonary stenosis) in Groups A and B.

The relatively low prevalence of complex cardiac lesions in our study is probably related to the age of the studied patients, and reflects the high mortality of these complex lesions in our country early in life. The incidence of CHD of 11.5/1,000 live births at our center is higher than that reported in the literature, with evidence of more frequent ventricular septal defects and pulmonary atresia lesions. This may be related to high rate of consanguinity in our population. This review underscores the need for a national cardiac registry center for children in a developing country like Lebanon. Such a database will allow referral and care of complex cardiac lesions.