Congenital heart disease in adolescents and adults. Analysis of patients discharged from general hospitals in the metropolitan area, during 1998

Abstract

The incidence and prevalence of congenital heart disease (CHD) in Costa Rica and other underdeveloped countries is unknown. In spite of having a broad nationwide heath coverage we still see untreated adults with CHD. Given the demographic growth and the decline in infancy mortality the modern physician faces a larger number of people with CHD, whom he has to diagnose, refer or advise. In order to learn more about our own reality, particularly of adults with CHD, we studied all the patients discharged from the metropolitan area hospitals. We choose the year of 1998 in order to have recent information, and to provide us with al least 2 years of follow up data.

There were 45 adults, 75% were women and 25% were males, with a range of 15 to 64 years of age. Most of them had been born and came from the province of San Jose.

Sixty six percent of the patients had atrial septal defect, 11.5% had ventricular septal defect, 4.4% had Tetralogy of Fallot and there was a case each of aortic coarctation, aortic stenosis, Ebstein's anomaly, truncus arteriosus, congenital AV block, and sinus of Valsalva fistula.

In 61,53% the diagnos is was made when they were older than 10 years of age. In 81% of the adults the diagnosis was made when they were 2040 years old and in 19%, when they were between 46 to 65 years old.

Echocardiography was the most utilized and definitive exam.

Of the 34 women, 12 had children, there were 48 vaginal deliveries and 8 csections without mortality or complications. One ASD patient had a child with ASD. Thirty two patients were corrected during the year of the study and all survived their surgeries. Obstetrical indications and medical treatment were the other reason for hospital admission. The NYHA functional class was 1 in 30 of 32 individual submitted to surgery.

Twenty four subjects were employed and 2 had already retired. One patient with Down's and one with truncus arteriosus who had refused surgery were disabled. Nine individuals had problems performing a job and in 9 this information was not recorded.

From these data we can gather that the diagnosis of CHD is been made late in comparison with other countries. Most of the patients are referred to the metropolitan area with the diagnosis already made. The surgical treatment is highly successful and the patients are able to join the work force and procreate normally.