Major Category Proportions of Congenital Heart Disease in 28772 Cases

Background and Objective:Congenital heart disease(CHD) is one of the most common congenital malformations in newborns affecting 6‰～8‰of newborn babies in China. Considering its severe impact on the life and physical and mental health of the children and the heavy economic and psychological burdens to the family and the society,CHD has become one of the most important public health problems affecting Children's health and lowering the life quality of the whole population.Numerous studies have been reported on the incidence and the related factors of CHD worldwide,but the incidence and categories of CHD vary depending on different countries,regions and periods.There are rare reports on the incidence of CHD in Zhejiang Province,and the category proportions might change with the economic development,environment pollution,improvement of people's lifestyle,and technical improvement of the ultrasound examination.This study aimed to investigate the growing trend of CHD cases in Zhejiang Province,the disease categories of CHD,and the age distribution, which will provide the scientific basis for CHD prevention and treatment and reference data for future surveillance and intervention research work.This analysis can also help to advocate the "healthy pregnancy and scientific nurture" education,promote prenatal diagnosis and postnatal physical examination and echocardiography,maximally reduce CHD incidence,and alleviate economic and psychological burdens.Methods:A total of 28772 cases of CHD were enrolled into this study,who were inpatients or outpatients diagnosed by echocardiography at our hospital from January 2003 to December 2008.Among them,15069 were boys and 13703 were girls,aged 1 day to 18 years(median:8 months).The first time were taken into this study for patients with multiple examinations.Echocardiography was performed by physicians conforming to unified protocols,standards and requirements;the upper physicians would be consulted in case of any question during the examination.Data were collected and graphs were made using EXCEL software.Statistical analysis was made using SPSS 13.0 software, and P values less than 0.01 were considered statistically significant.Results:(1) From January 2003 to December 2008,28772 cases of CHD were identified, with 30 categories of the disease.The identified case of CHD increased during 2003-2008 with small fluctuation,showing linear direct correlation with time(r:0.893; b=727.829).The CHD cases increased from 3062 in 2003 to 7479 in 2009,with an increased number of 4417(144.25%) during the 6 years;the increase was especially rapid from 5052 in 2007 to 7479 in 2008,with an added number of 2427.(2) The 6 predominant categories of CHD in this study were interventricular septal defect(10330 cases,35.90%),atrial septal defect(9052,31.46%),patent ductus arteriosus(4145,14.41%),pulmonary artery stenosis(1231,4.28%),tetralogy of Fallot (884,3.07%),and transposition of the great arteries(418,1.45%).(3) There was a decrease in the proportion of CHD cases at each age as age increased,with the decrease gradually reducing:Y=-2.211+28.503/X(R:0.995; P＜0.01).The proportions of CHD cases aged＜1 years,＜4 years,and＜7 years were 56.41%,81.57%and 91.37%,respectively.In cases with atrial septal defect,those aged＜3 years accounted for 80.43%;in cases with interventricular septal defect or patent ductus arteriosus,those aged＜4 years accounted for 80.91%and 83.54%,respectively; in cases with pulmonary artery stenosis or tetralogy of Fallot,those aged＜5 years or＜6 years accounted for over 80%,respectively.The proportions of cases with interventricular septal defect,atrial septal defect,and patent ductus arteriosus at different ages were similar to that of the whole study group. The proportion,of cases with interventricular septal defect was highest(around 40%) at 1 - 5 years age,and declined at 5 - 9 years even though there was a slight increase after 9 years.Atrial septal defect peaked at 34.0%at＜1 years age,then decreased with minor increase after 8 years.The proportion of cases with patent ductus arteriosus changed little as age increased.Conclusions:(1) The identified cases of CHD increased during the period of 2003-2008.(2) The 6 predominant categories of CHD were interventricular septal defect,atrial septal defect,patent ductus arteriosus,pulmonary artery stenosis,tetralogy of Fallot, and transposition of the great arteries.(3) There was a decrease in the proportion of CHD cases at each age as age increased,with the decrease gradually reducing.CHD cases were mainly identified during infancy..