Cholelithiasis in children with CHD: is it a problem?

Area of Science:

• Pediatric Cardiology
• Gastroenterology
• Surgical Outcomes

Background:

• The link between heart disease, its treatments, and gallstones is widely believed.
• This study investigates the prevalence, risk factors, and management of gallstones in children with congenital heart disease (CHD).
• The specific role of open-heart surgery in gallstone formation in CHD patients was examined.

Purpose of the Study:

• To determine the prevalence of gallstones in pediatric patients with CHD.
• To identify risk factors associated with gallstone formation in this population.
• To analyze treatment strategies for gallstones in children with CHD, evaluating the impact of cardiac surgery.

Main Methods:

• A 10-year retrospective chart review of patients diagnosed with both CHD and cholelithiasis between 2005 and 2014.
• Patients were categorized into two groups: those who underwent cardiac surgery before gallstone diagnosis and those who did not.
• Data on gallstone prevalence, risk factors, and treatment outcomes were analyzed.

Main Results:

• The overall prevalence of cholelithiasis in children with CHD was 0.4% (19 out of 4729).
• Prevalence was 0.3% in patients who had undergone cardiac surgery versus 0.5% in those who had not.
• Gallstones were incidentally found in nine asymptomatic patients; 17 children had cholecystolithiasis, with 15 successfully managed non-operatively using ursodeoxycholic acid.

Conclusions:

• Gallstone prevalence in children with CHD is lower than anticipated, despite risk factors.
• Open-heart surgery, particularly with cardiopulmonary bypass, appears to play a minimal role in gallstone etiology.
• Cholelithiasis in CHD patients is often incidental and manageable non-operatively; prophylactic ursodeoxycholic acid is not recommended, and surgery is reserved for symptomatic cases.