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PubMed1991

[Regional differences in the prevalence of congenital heart defects].

Prevalence of congenital heart diseases was studied prospectively in all 664,218 infants live born in Bohemia from 1977 to 1984. All children who died were autopsied and those suspected of having a heart disease were examined at the specialized center. In total, 664/100,000 infants were born with a heart defect, most of them in Prague (957,9/100,000) and in Central Bohemia (739.4) and in Northern Bohemia (619.3). The lowest prevalence was found in West Bohemia (515.1/100000 live births). The relative frequency of congenital heart defect categories differed significantly among regions. Evidence of regional differences in prevalence of congenital heart diseases and their forms suggests that environmental factors can play an important role in the etiology of congenital heart defects.

Czechoslovakia↗
PubMed1991

[Seasonal differences in the occurrence of congenital heart defects].

Incidence of congenital heart defects was studied prospectively in all 664,218 children born in 1977 to 1984. Those suspected of having a heart disease were examined at the center specialized in pediatric cardiology. All children who died were autopsied and those in whom a heart defect was proved were included in our series. In total, 4409 infants (6.64/1000 live births) were born with a heart defect in Bohemia. Differences from one year to another were not statistically significant. The incidence of infants with a heart defect was highest in October, lowest in December, June and July (p less than 0.05). Seasonal incidence of individual forms of heart defects differed as well. The seasonal variation was not influenced by the total number of live births. High incidence of congenital heart defects in infants born in October and November coincides with the epidemics of influenza in early pregnancy.

Czechoslovakia↗
PubMed2000

[Heart rhythm variability of healthy newborns with congenital heart defects].

Short-term changes in heart rate (heart rate variability) are seen at every age and represent an important sign of normal homeostatic mechanisms of the cardiovascular system. The influence of premature birth on the maturation of the autonomic nervous system was established by studying heart rate variability in 12 pre-term newborns. The results were compared with a group of 88 full-term newborns and with a group of 14 newborns with congenital heart defects. Heart rate variability was measured by spectral- and time-domain analysis of interbeat intervals in 4-hour continuous ECG recordings. In comparison with full-term newborns, pre-term newborns had significantly lower (p < 0.05) time-domain indices (SDNN = 42.73 vs. 53.38; SDANN-i = 29.84 vs. 35.7) and spectral-domain indices (ULF = 7.91 vs. 10.29; VLF = 20.28 vs. 27.42; LF = 12.57 vs. 16.46). The present results point to a significant influence of gestational age on heart rate variability. Newborns with congenital heart defects present a different pattern of activity of the autonomic nervous system.

Arrhythmias, Cardiac↗
PubMed2004

Partnership for the heart. German-Estonian health project for the treatment of congenital heart defects in Estonia.

Congenital heart defects (CHD) occur in 8 per 1000 live births. If they remain untreated, 70-80% of these patients die in early childhood. With modern diagnostic and treatment procedures, 90% of these patients reach adulthood. Within 8 years following reunification of Germany, it was possible to improve treatment for CHD in former East Germany to West German standards. Based on the experience gained in this process, a plan for improvement of care of Estonian patients with CHD was developed and implemented in the German-Estonian project, "Partnership for the Heart". The main elements of the project were (1) the training of Estonian physicians in Germany, (2) training courses conducted by German and Estonian specialists in Estonia and (3) use of telemedicine for consultation on a continuous basis. During the project 15 Estonian patients underwent cardiac surgery and/or catheter interventions performed by a joint team of German and Estonian specialists. The infant mortality due to CHD in Estonia fell by 28% during the project period. Key techniques of cardiac surgery are now being employed in Estonia without outside support, indicating the success of the training program and the long-term improvements to cardiac health care in Estonia. The total project costs were 314,252 Euro (euro), which is 50% lower than the estimated cost of treating the 15 patients abroad in Western Europe. The structure of "Partnership for the Heart" and the modified self-sufficiency model of medical care have not only produced results for Estonia but can be taken as a template for future bilateral health projects with other transition countries and for other fields of medical specialisation, and thus might aid a European health policy.

Adolescent↗
PubMed2000

[Current cardiology and congenital heart defects in adults].

Congenital heart defects (CHD) are referred to in coincidence with any anomaly of anatomic structure of the heart and large vessels. The prognosis of CHD has improved dramatically in th recent 50 years. The number of patients with CHD surviving until adulthood is increasing.

Adult↗
PubMed1991

Late results of surgery for congenital heart defects.

Surgery for congenital heart defects started 50 years ago with "closed" procedures, and open heart surgery is in its forth decade. Thus, long-term results are now available. Although a majority of patients lead normal lives, problems do exist. Hemodynamic anomalies can be related to residual lesions or to persistent systemic hypertension (after coarctation repair) or pulmonary hypertension (after late repair of left to right shunt lesions). Right or left ventricular dysfunction may be observed, due to longstanding overload, hypoxia or to the open heart procedure itself. Rhythm disturbances have a tendency to increase with the passage of time after surgery. After ventricular surgery (repair of ventricular septal defect and tetralogy of Fallot), conduction defects and ventricular arrhythmias are prevalent. They may lead to late sudden death. After atrial surgery, sinus node dysfunction and atrial arrhythmias are observed. Problems related to growth of the patient exist essentially in cases where foreign material (conduits, prostheses) have been implanted. Many patients, with definitive repair or palliative operation, have become adults. This is a new challenge for the adult cardiologist, and it is a duty of the pediatric cardiologist to hand over his knowledge of this pathology.

Adolescent↗