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Cardiac anomalies in children with congenital duodenal obstruction: a systematic review with meta-analysis
Adinda G H Pijpers1, Laurens D Eeftinck Schattenkerk2, Ralph de Vries3
1Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1005 AZ, Amsterdam, The Netherlands. a.pijpers1@amsterdamumc.nl.
Insights
Cardiac anomalies affect approximately one-third of patients with duodenal obstruction (DO). Screening for these heart conditions is recommended for all DO patients, irrespective of Trisomy 21 status.
Area of Science:
- Pediatric Cardiology
- Neonatal Surgery
- Medical Genetics
Background:
- Congenital duodenal obstruction (DO) is frequently associated with cardiac anomalies, but their precise incidence and types are not well-defined.
- This systematic review aims to consolidate existing literature on cardiac anomalies in patients diagnosed with DO.
Approach:
- A comprehensive literature search was conducted in July 2022 across PubMed and Embase.com.
- Eligible studies included those detailing cardiac anomalies in patients with congenital DO.
- Meta-analysis was employed to pool data on the prevalence of cardiac anomalies, specific anomaly types, DO classifications, and Trisomy 21 incidence.
Key Points:
- The review analyzed 99 publications encompassing 6725 patients.
- A pooled prevalence of 29% for cardiac anomalies was observed in patients with DO.
- Common anomalies included persistent foramen ovale (35%), ventricular septal defect (33%), and atrial septal defect (33%).
- Type 3 DO (complete atresias) was the most prevalent obstruction type (54%).
- The pooled prevalence of Trisomy 21 in DO patients was 28%.
Conclusions:
- Cardiac anomalies are present in approximately one-third of patients with duodenal obstruction.
- The occurrence of cardiac anomalies in DO patients is independent of Trisomy 21 status.
- Preoperative cardiac screening is recommended for all patients diagnosed with duodenal obstruction.
Background:
Cardiac anomalies occur frequently in patients with congenital duodenal obstruction (DO). However, the exact occurrence and the type of associated anomalies remain unknown. Therefore, the aim of this systematic review is to aggregate the available literatures on cardiac anomalies in patients with DO.
Methods:
In July 2022, a search was performed in PubMed and Embase.com. Studies describing cardiac anomalies in patients with congenital DO were considered eligible. Primary outcome was the pooled percentage of cardiac anomalies in patients with DO. Secondary outcomes were the pooled percentages of the types of cardiac anomalies, type of DO, and trisomy 21. A meta-analysis was performed to pool the reported data.
Results:
In total, 99 publications met our eligibility data, representing 6725 patients. The pooled percentage of cardiac anomalies was 29% (95% CI 0.26-0.32). The most common cardiac anomalies were persistent foramen ovale 35% (95% CI 0.20-0.54), ventricular septal defect 33% (95% CI 0.24-0.43), and atrial septal defect 33% (95% CI 0.26-0.41). The most prevalent type of obstruction was type 3 (complete atresias), with a pooled percentage of 54% (95% CI 0.48-0.60). The pooled percentage of Trisomy 21 in patients with DO was 28% (95% CI 0.26-0.31).
Conclusion:
This review shows cardiac anomalies are found in one-third of the patients with DO regardless of the presence of trisomy 21. Therefore, we recommend that patients with DO should receive preoperative cardiac screening.
Level Of Evidence:
II.
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