Journal of Health and Medical Sciences

Background: Congestive heart failure (CHF) is a chronic progressive condition that affects the pumping power of your heart muscles. While often referred to simply as "heart failure," CHF specifically refers to the stage in which fluid builds up around the heart and causes it to pump inefficiently. An evaluation of screening for CHDs is very important, echocardiography is a non-invasive technique and Modern two-dimensional echocardiographic strategies offer a comprehensive way for evaluating virtually all types of CHD observed in both adults and children. Objective: The aim of this study is to find out the most common clinical presentation of congenital heart defects in children from 3 months to 16 years of age referred to echocardiography and confirm the presence of disease on echocardiography in Children Hospital Lahore. Methods: This is a descriptive and prospective Hospital-based study conducted in the pediatric cardiology unit outpatient department of CHILDREN HOSPITAL. This study included all the patients, irrespective of age, having confirmed the diagnosis of CHD on the basis of echocardiographic report. Results: In my study, 288 patients of clinically Diagnosed CHD referred to echocardiography were studied. Congenital heart defects were diagnosed more commonly between 3 months to 5 Years than other age groups. The reason for the higher incidence in the age group of 3 months to 5 years maybe that CHD becomes symptomatic at that age group. The commonest congenital heart defects with a single lesion in our study were Ventricular septal defect followed by Atrial septal defect, Tetralogy of Fallot, Patent ductus arteriosus Conclusions: We observed that Symptomatic patients mostly present in 3 months -5 years of age. At 0.16-5 year of age child presented with sweating, respiratory distress, syncope and tachypnea. While from 5-16 years, commonest symptoms were murmur, chest pain, respiratory distress, tachypnea. The most symptomatic lesion Congenital heart defects were Ventricle septal defect and Teratology of fallot Ventricle septal defect, Atrial septal defect Pulmonary stenosis. Transthoracic echocardiography is an important tool for confirmation of clinical presentations of CHD at different age group. dysfunction, pulmonary stenosis, pulmonary hypertension, and coarctation of the aorta.


Introduction
As a relevant a part of the circulatory device, the heart is in most cases accountable for pumping blood and dispensing oxygen and vitamins all through the body considered one of the most important organs, such that even small dysfunctions or abnormalities may additionally purpose drastic changes or effects in the human organism.The organ is divided into numerous chambers followed by way of veins and arteries that facilitate the equal characteristic.The valves that separate those chambers are called atrioventricular valves.The systole is a short duration that occurs whilst the tricuspid and mitral valves close; the diastole is a rather longer length while the aortic and pulmonary valves close.The systole-diastole courting is the reference in measuring blood pressure.Other approaches of bodily figuring out the normal functioning of the heart is through examining the heartbeat rate (beats per minute).The interventricular septum separates the right from the left ventricle.The valve among the right atrium and right ventricle are made up of 3 essential leaflets of unequal size.The outlet of the pulmonary artery is guarded by using a valve referred to as the pulmonary valve.This valve prevents the again flow of blood from the pulmonary trunk into the right ventricle when the ventricular muscle relaxes.Two pulmonary veins bring the arterial or oxygenated blood out of each lung.The 4 pulmonary veins empty their contents into the left atrium of the heart.The valve separating the left atrium from the left ventricle is known as the left atrio-ventricular valve, or mitral valve, and consists of cusps.It's far smaller than the tricuspid orifice.Inside the left ventricle, the 2 groups of papillary muscles arise from the junction of the apical and middle 1/3 of the ventricular wall (Mesotten et al.,1998).
Congenital heart disease (CHD) discuss with structural or purposeful heart sicknesses, that are present at delivery.These are visible in neonates, babies and children, even though in our country it is not uncommon to peer adults with uncorrected CHD (Saxena, 2005).The incidence of CHD in extraordinary studies varies from about four/1,000 to 50/1,000 stay births.The relative frequency of different most important kinds of CHD additionally differs greatly from look at to examine.In addition, every other 20/1,000 stay births have bicuspid aortic valves, remoted anomalous lobar pulmonary veins or a silent patent ductus arteriosus (Hoffman and Kalpan, 2002).Congenital heart disease is structural abnormality of heart or blood vessels near the heart, present either on the time of start or detected afterward (MEMON et al.,2012).They are the maximum, not unusual birth defects, happening in zero.Five-0.Eight% of stay births, three-4% of nevertheless births; and 10-25% of abortuses (George and Frank,2009).Non-Invasive Cardiac diagnostic technique (like TTE) plays foremost within the prognosis of CHD.An echocardiography has to be completed without delay (Jatav et al.,2018) Echocardiograms can follow the response to the lower inside the LVOT gradient and improvement in diastolic function following scientific remedy (Levy et al.,2014).An entire-dimensional echocardiography examination to the recommendations of the American Society of Echocardiography (KLEINMAN et al.,1981).Over the beyond 20-30 years, important advances were made in the diagnosis and treatment of CHD.Echocardiography is a non-invasive technique and Modern two-dimensional echocardiographic strategies offer a comprehensive way for evaluating virtually all types of CHD observed in both adults and children (Sani et al.,2007).Congenital heart defects (CHDs) are accountable for up to 40% of all deaths from congenital anomalies and account for 3-7.5% of all infant deaths.An evaluation of screening for CHDs presents numerous challenges as "congenital coronary heart defects" is a time period that includes many exceptional structural heart malformations with various incidence, medical functions, herbal history, interventions, and probable advantage from screening.Moreover a few CHDs, for example, a few muscular ventricular septal defects (VSDs), are of no useful or clinical result and may resolve spontaneously in early life.In figuring out the most useful screening techniques for CHDs, it is vital to bear in mind the perfect goals of screening.The cutting-edge screening pathway for CHDs is complex and sequential screening techniques aren't integrated throughout fetal and neonatal existence neither is the impact of antenatal screening on newborn screening nicely-described (Knowles et al., 2013).Studies of the prevalence of CHD generally estimate the total prevalence and the proportions of different CHDs (Hoffman and Kalpan, 2002).There are minor changes in the different heart defects with seemingly moderate growth in the burden of tetralogy of Fallot and atrial septal defects and a moderate decrease in the burden of patent ductus arteriosus (Abdulkadir, 2016).Consanguinity performs a first-rate role within the occurrence of predominant congenital malformations in kids.The occurrence of CHD is not uniform in our united states, as numerous studies have suggested it ranging from 1 to 50.89 in line with a thousand stay (Kumar B.D et al., 2015).Three-dimensional strategies are actually firmly mounted for imaging of congenital heart defects.Once the 3-dimensional dataset has been received, it can be interrogated in any desired photograph plane.The viewing alternatives include visualization as a three-dimensional photo or as a two-dimensional image cut in any desired axis (multi-planar reformatted) (Kumar, A et al., 2017).Apparent will increase in the prevalence of CHDs are therefore probable to be due to expanded detection of these minor defects as echocardiography is more often used for cardiac investigation.Life-threatening CHDs consist of the hypoplastic left heart (HLH), interrupted aortic arch (IAA), transposition of the first-rate arteries (TGA), obstructed overall anomalous pulmonary venous connection (TAPVC), coarctation of the aorta (COA), crucial aortic stenosis (AS) and pulmonary atresia (PA).(Simpson,2008).The maximum customary lifestyles-threatening defects at live delivery are coarctation of the aorta (COA) and essential aortic stenosis (AS); the ventricular septal defect is the most common CHD but not likely to result in collapse or to die (Knowles et al., 2013).

Methods
An Observational and Cross-sectional study was conducted at Children Hospital, Ferozpur road Lahore.Our sample size was 288 patients.288 patients were included after the approval of synopsis from institutional review board (IRB).All the patients of Age group 3 months to 16 years were diagnosedwith congenital heart defect, referred to echocardiography and confirm the presence of disease on echocardiography.Echocardiography machine GE(vivid) was used wasused to perform this research to find out the most common clinical presentation of congenital heart defect in children from 3 months to 16 years of age referred to echocardiography and confirm the presence of disease on echocardiography in Children Hospital.Figure 6 shows a ventricular septal, Dilated MPA and TOF can be diagnosed in Figure 7.

Results
This descriptive study was based on 3 months' time period and 288 patients of congenital heart disease were studied.A Performa was used for each patient, which were filled based on clinical presentation and Echo cardio graphic findings.
Table 4 shows that asymptomatic patients mostly present in 3M-5 years of age.At 3M-5years child presents with respiratory distress, followed by sweating, Tachypnea, chest pain, cyanosis, syncope, murmur, fits, and spell.These were common clinical presentations up to 5 years of age.The commonest clinical presentations in 5-10 years child were respiratory distress and sweating and less common one's clinical presentations are murmur, spell and fits.In 10-16 years, respiratory distress is the most common clinical presentation.Table 4 shows that the commonest congenital heart defects with single lesion confirmed by echocardiography in our study was Ventricular septal defect (n=30, 45.4%) followed by Patent ductus arteriosus (n=14, 21.2%)TetralogyOf Fallot (n=11, 16.60%), Atrial septal defect (n=7, 10.6%), and complete atrioventricularseptal defect(n=4,6.10%).

Discussion
CHDs are the most common congenital fetal malformations accounting of all congenital malformations and are responsible for a high rate of child mortality and morbidity.In this study, patients presented with the most common clinical presentation of a congenital heart defect in children from 3 months to 16 years of age referred to echocardiography were included.
In my study, 288 patients of clinically suspected CHD referred to echocardiography were studied.CHD is more common in men than women as in my study, it was clearly demonstrated that male patients outnumbering the female.Congenital heart defects were diagnosed more commonly between 3 months to 5 Years (72.22%) than other age groups.The reason for the higher incidence in the age group of 3 months to 5 years maybe that CHD becomes symptomatic at that age group.Clinical presentation, according to the age of children, shows that asymptomatic patients mostly present in 2-5 years of age.At 0.16-2 year of age child presents with murmur followed by sweating &interrupted feeding, respiratory distress, syncope and Tachypnea.While in 2-5 years of age, they present with a murmur, syncope, respiratory distress, chest pain, and Tachypnea.These were common clinical presentations up to 5 years of age.
The commonest clinical presentation above 5 years child was chest pain, respiratory distress, Tachypnea and syncope, and less common one's clinical presentations were our cyanosis, spell and fits.This study added theses age-wise distribution of clinical presentation, which was not present in all these previous studies.

Conclusion
Symptomatic patients mostly present in 3 months -5 years of age.At 0.16-5 year of age child presented with sweating, respiratory distress, syncope and tachypnea.

Figure 3 :
Figure 3: Frequency of Clinical findings of the CHD in Symptomatic patients

Figure 4 :
Figure 4: Age-wise distribution of clinical presentations of Congenital Heart Diseases

TABLE 1 :
Sex wise distribution of congenital heart diseases

Table 3 :
Frequency of Clinical findings of the CHD in Symptomatic patients

Table 4 :
Age-wise distribution of clinical presentations of Congenital Heart Diseases The commonest congenital heart defects with a single lesion in our study were Ventricular septal defect 23.95% followed by Atrial septal defect 11.5%, Tetralogy of Fallot 10.1%, Patent ductus arteriosus 8.33%.Mahapatra A  et al. (2017)this study was very similar to study conducted by Mahapatra.They conducted a retrospective hospital-based study of 231 patients over a period of 20 months.Where all suspected children less than 14 years of CHD were subjected to Echocardiographic study.The age, sex, clinical presentation and echo findings were well documented.The male to female ratio was found 1.2:1.The most common CHD was diagnosed in 1 month to 1 Year (40.25%).Ventricular septal defect (36.3%)Tetralogy of Fallot (11.25%) was the commonest type of a CHD.The major clinical presentation was a detection of a respiratory distress (84.8%) followed by tachycardia (41.5%) and Tachypnea (36.3%).ManjuleswariN, et al. (2016)work on 3853 patients in the pediatric ward in which 60 were diagnosed.Peak incidence was seen in the age group of 1-12 months, comprising of 46.67% of the total number of cases.Males' patients were 53.49% and females 46.51%.The commonest CHD was Ventricular septal defect (58.14%) and TOF (35.29%).The result of my study was the same as Manjuleswaristudy.
While from 5-16 years, commonest symptoms were murmur, chest pain, respiratory distress, tachypnea.The most symptomatic lesion Congenital heart defects were Ventricle septal defect and Teratology of Fallot Ventricle septal defect, Atrial septal defect Pulmonary stenosis.Transthoracic echocardiography is an important tool for confirmation of clinical presentations of CHD at different age groups.