Challenges on the management of congenital heart disease in developing countries

Int J Cardiol. 2011 May 5;148(3):285-8. doi: 10.1016/j.ijcard.2009.11.006. Epub 2009 Nov 22.


Introduction: While in developed countries prenatal diagnosis is currently used to detect Congenital Heart Disease before (CHD) before birth, in developing countries only a minority of children with CHD is detected and few benefit from surgical treatment. Having created a referral unit for diagnosis and treatment of cardiovascular diseases in a resource-deprived country we designed a study aiming at describing the spectrum and characteristics of CHD and discuss the challenges of its management.

Population and methods: We studied retrospectively all patients assisted at a referral unit between 2001 and 2007, collecting epidemiological, clinical, echocardiographic and surgical data from hospital files.

Results: We studied 534 patients with median age at diagnosis of 4 years (range 0-79); 296 were females (55.4%). Only 282 (52.8%) patients were diagnosed under the age of two years, and complications were present in 155 (29.0%) at time of diagnosis. We operated 196 patients with mean age of 8±10 years. Only 29 of the 111 complex defects were considered for surgery. The 30-days post-operative mortality was 8/196 (4.0%). The most important post-surgical complications were post pericardectomy syndrome (22).

Discussion: A pattern of late presentation accompanied by high rate of complications was found. In resource-deprived settings the approach to the management of CHD emphasizes the treatment of "curable" malformations. Surgery for CHD in these settings must be linked to early detection and a referral system in which general practitioners, pediatricians, obstetricians and cardiologists interact in the design and implementation protocols for diagnosis, management and follow-up of patients.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Developing Countries / economics*
  • Disease Management
  • Female
  • Heart Defects, Congenital / economics*
  • Heart Defects, Congenital / epidemiology
  • Heart Defects, Congenital / therapy*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Mozambique / epidemiology
  • Retrospective Studies
  • Young Adult