Cardiology in the Young

Original Articles

Detection rates of congenital heart disease in Guatemala

Sara M. Truccoa1 c1, Joaquin Barnoyaa2a3, Luis Alesandro Larrazabala1, Aldo Castañedaa2 and David F. Teitela1

a1 Pediatric Cardiology, University of California San Francisco, San Francisco, California, United States of America

a2 Pediatric Cardiothoracic Surgery, Unidad de Cirugia Cardiovascular de Guatemala, Guatemala City, Guatemala

a3 Department of Surgery, Washington University in St. Louis School of Medicine, Saint Louis, Missouri, United States of America

Abstract

Objectives In developing countries, congenital heart disease is often unrecognised, leading to serious morbidity and mortality. Guatemala is one of the few developing countries where expert paediatric cardiac treatment is available and affordable, and therefore early detection could significantly improve outcome. We assessed regional congenital heart disease detection rates in Guatemala, and determined whether they correlated with the regional human development index.

Methods We retrospectively reviewed all new cardiac referrals made in 2006 to the Unidad de Cirugia Cardiovascular Pediatrica, the only paediatric cardiac centre in Guatemala. We calculated regional detection rates by comparing the number of congenital heart disease referrals with the expected incidence using the National Ministry of Health birth data. We then compared the regional detection rates with the human development index data published in the United Nations 2006 Development Program Report using Spearman’s rank correlation.

Results An estimated 3935 infants with cardiac defects were born in Guatemala in 2006, an expected 1380 (35%) of whom had severe forms. Overall, only 533 children (14%) with cardiac defects were referred. Of these, 62% had simple shunt lesions, 13% had cyanotic lesions, and 10% had left-sided obstructive lesions. Only 11.5% of referred patients were neonates. Regional detection rates, ranged 3.2–34%, correlated with the regional human development index (r = 0.75, p < 0.0001).

Conclusions Current detection of congenital heart disease in Guatemala is low and correlates with the regional human development index. Those detected are older and have less severe forms, suggesting a high mortality rate among Guatemalan neonates with complex cardiac defects.

(Received June 22 2010)

(Accepted September 20 2010)

(Online publication December 08 2010)

Correspondence:

c1 Correspondence to: S. M. Trucco, MD, Pediatric Cardiology, University of California, San Francisco, 505 Parnassus Avenue, PO Box 0544, San Francisco, California 94143, United States of America. Tel: 415 353 4141; Fax: 415 353 4144; E-mail: smtrucco@gmail.com