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Distribution of symptomatic congenital heart disease in Hong Kong
E G Jacobs1, M P Leung, J Karlberg
1Department of Paediatrics, Paediatric Cardiological Division, the University of Hong Kong, Grantham Hospital, 125 Wong Chuk Hang Road, Aberdeen, Hong Kong SAR, China.
Insights
This study analyzed congenital heart disease (CHD) in young Chinese children, finding pulmonary outflow obstruction more common than in Western populations. Specific cardiac lesions showed distinct frequencies in this ethnic group.
Area of Science:
- Pediatrics
- Cardiology
- Public Health
Background:
- Racial and ethnic variations in congenital heart disease (CHD) occurrence are documented.
- Understanding the specific profile of CHD in diverse populations is crucial for targeted healthcare.
- Previous studies have highlighted differences in CHD prevalence across ethnic groups.
Purpose of the Study:
- To determine the frequency and clinical characteristics of symptomatic congenital heart disease in children in Hong Kong.
- To compare the epidemiological profile of CHD in Southern Chinese children with findings from Western studies.
- To identify specific CHD subtypes that may be more or less prevalent in the Chinese pediatric population.
Main Methods:
- Retrospective analysis of hospital records for 666 children (≤4 years old) with symptomatic CHD admitted in 1994-1995.
- Categorization of CHD based on physiological (shunting) and anatomical features.
- Statistical comparison of lesion frequencies with existing Western cohort data.
Main Results:
- Left-to-right shunting (45.0%) and pulmonary outflow obstruction (34.4%) were the most common CHD categories.
- Pulmonary outflow obstruction (e.g., Tetralogy of Fallot, critical pulmonary stenosis) was significantly more frequent in Chinese children than in Western cohorts (p<0.0001).
- Coarctation of the aorta (5%) appeared common, while aortic stenosis and hypoplastic left ventricle seemed rare in this cohort. Ventricular septal defect was predominant in Chinese children with Down's syndrome.
Conclusions:
- Congenital heart disease patterns in Hong Kong children differ from Western populations, notably with increased pulmonary outflow obstruction.
- Specific lesions like coarctation of the aorta may be more prevalent in Chinese children, contrasting with Western data.
- Mortality rates varied by CHD type, with intracardiac mixing and left ventricular outflow tract obstruction posing the highest risks.
Abstract:
Racial group studies have identified differences in the occurrence of congenital heart disease (CHD) among ethnic populations. The aim of this study was to characterize the proportionate frequency and clinical profile of children with symptomatic cardiac abnormalities in Hong Kong. The hospital records of 666, mainly Southern Chinese children with symptomatic CHD, who were 4 years of age or younger and who were admitted to Grantham Hospital, Hong Kong, in 1994 and 1995 were analyzed retrospectively. Left-to-right shunting (45.0%) and pulmonary outflow obstruction (34.4%) were the most frequently diagnosed categories, followed by left ventricular outflow obstruction (8.3%), transposition of the great arteries (4.2%), conditions with intracardiac mixing (3.9%), and other cardiac lesions (4.2%). Compared with Western studies, pulmonary outflow obstruction (p<0.0001), particularly tetralogy of Fallot and critical pulmonary stenosis, were more frequent in Chinese children. In contrast with previous reports, coarctation of the aorta (5%) does not seem to be uncommon in Chinese patients. Conversely, aortic stenosis and hypoplastic left ventricle may be rare in these children (1% vs 3% and 3-7%). Other cardiac lesions showed no consistent racial difference in the frequency of occurrence. Chinese patients with Down's syndrome had ventricular septal defect (38%) as the predominant lesion followed by atrioventricular septal defect (25%). Western studies usually report a reverse pattern for these two lesions. The mortality rate for the total cohort was 7.5%. However, of those with conditions with intracardiac mixing and left ventricular outflow tract obstruction many did not survive childhood (20% and 21%, respectively).