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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 1  |  Issue : 2  |  Page : 85-87

Pattern of congenital heart defects among children with orofacial clefts in Northern Nigeria


Paediatric Cardiology Unit, Department of Paediatrics, Aminu Kano Teaching Hospital, Kano, Nigeria

Date of Web Publication2-Aug-2014

Correspondence Address:
Dr. M O Asani
Cardiology Unit, Aminu Kano Teaching Hospital, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-2125.137895

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  Abstract 

Background: The prevalence of congenital heart defects (CHD) in children with cleft lips (CLs) and palate (CP) is reportedly higher than the general population. Several studies have described diverse rate of CHD in different localities. Aims and Objectives: To the authors' knowledge, the frequency and pattern of CHD among children with CLs and CP has not described in this geopolitical zone. Materials and Methods: This is a retrospective study of the echocardiographic records of all cases of CL and CP seen over a 4 years period, between November, 2010 and October, 2013. Data were analyzed and expressed using frequency tables and percentages. Results: A total 30 children were referred for echocardiographic screening (ECGS) during the period. There were 17 males and 13 females, giving a male:female of about 1:1. The age range was between 15 days and 12 years with a median age of 4 months. There were 6 (20%) cases of CHDs. Conclusions: The relatively high rate of CHD among children with oral clefts in this study justifies the need for ECGS for these categories of children.

Keywords: Oral clefts, children, heart defects


How to cite this article:
Asani M O, Aliyu I. Pattern of congenital heart defects among children with orofacial clefts in Northern Nigeria. J Cleft Lip Palate Craniofac Anomal 2014;1:85-7

How to cite this URL:
Asani M O, Aliyu I. Pattern of congenital heart defects among children with orofacial clefts in Northern Nigeria. J Cleft Lip Palate Craniofac Anomal [serial online] 2014 [cited 2019 Aug 26];1:85-7. Available from: http://www.jclpca.org/text.asp?2014/1/2/85/137895


  Introduction Top


Cleft lip (CL) and/or palate (CP) have been described as the most common craniofacial congenital facial defect by several workers, and its incidence is said to be one out of every 500-1000 live births worldwide. [1] The condition occurs worldwide, the Asian population has been reported to have the highest prevalence, while African population has the least prevalence. [2],[3] To the author's knowledge, no community-based study has been conducted to determine the prevalence of CHD in the geopolitical zone, but the prevalent rate of CL and CP is 0.4/1000 live births in Nigeria. [4]

The prevalence of congenital heart defects in children with CLs and CP is reportedly higher than the general population. The incidence of cardiovascular anomalies in CL and CP is estimated to be 16-fold higher than that seen in the general population. [5] Aimede et al. [6] described a prevalence of 9.5% among patients with orofacial clefts in Abeokuta, Nigeria, [6] while Otaigbe et al. [7] in Port Harcourt, Nigeria reported a prevalence rate of 15% of congenital heart diseases (CHD) in CL/CP. In England, Geis et al. [8] reported an overall prevalence of 6.7%. Liang et al. [9] described a prevalence of 5.4% CHD in oral clefts. They found out that isolated atrial septal defect (ASD) and ventricular septal defect (VSD) are the two most common types of CHD. [9] Sun et al. also found out that 13.6% had CHD and that ASD was the most common CHD (39.7%). To the authors' knowledge, the frequency and profile of CHD among children with CLs and CP has not described in this geopolitical zone.


  Materials and Methods Top


This is a retrospective study of the echocardiographic records of all cases of CL and CP seen over a 4 years period, between November, 2010 and October, 2013. All cases for repair were referred to the cardiopulmonary clinic headed by the corresponding author. They were assessed clinically and screened for the presence of congenital heart defects. All were routinely sent for echocardiographic studies irrespective of whether they are symptomatic or not.

All transthoracic echocardiography studies were done by the authors. M-mode and two-dimensional images with Doppler interrogation for the presence of congenital heart diseases were carried out in the standard echo windows. All studies were carried out using ALOKA SSD cardiac ultrasound system and SSI-8000 SonoScape ultrasound system. Data were analyzed and expressed using frequency tables and percentages.


  Results Top


A total 30 children were referred for echocardiographic screening (ECGS) during the period. There were 17 males and 13 females, giving a male:female ratio of about 1:1. The age range was between 15 days and 12 years with a median age of 4 months.

There were 6 (20%) cases of CHDs. ASD (secundum) accounted for three cases. Although two had perimembranous VSD, the 6 th child had multiple shunt lesions (ASD and VSD). Palatal clefts with or without CLs, whether unilateral or bilateral account for four out of the six cases (66.7%) of CHD [Table 1] and [Table 2].
Table 1: Frequency of cleft by age and gender

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Table 2: Distribution of congenital heart disease

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  Discussion Top


A prevalence rate of 20% of congenital heart diseases among the children with oral clefts is a reflection of the high prevalence of CHD when compared to the general population, [1] although the small sample size in this study may influence the prevalence rate but the sample size is slightly higher than that reported by Otaigbe et al. [7] who reported a prevalence rate of 15% among 20 children of oral clefts. The prevalence rate in this study is however higher than the 9.5% described by Aimede et al. [6] and Barbosa et al. [10] described in Abeokuta, South-western Nigeria and Brazil respectively and Geis et al. [8] in England who reported a rate of 6.7%. The prevalent rate in our study is much lower than the 45.5% and 45.1% reported by Rawashdeh and Jawdat Abu-Hawas [11] from Jordan and Sun et al. from Eastern China, [12] respectively. These high prevalence rates, especially by Sun et al. [12] despite a large sample size of 2180 cases appears to justify our finding and attest to the multifactorial etiology of oral clefts, that is, interplay between genetics and environmental factors. [13]

All cases of CHD were of acyanotic type. This is similar to the finding by Otaigbe et al. [7] and Shafi et al. [14] who also found no cyanotic CHD, but it is in contrast to several studies [12],[15],[16] that described both cyanotic and acyanotic CHD in oral cleft patients. In this study, ASD was the most common CHD accounting for half of the cases seen and part of the multiple shunt lesions seen in a fourth case, this is similar to several studies [12],[14],[17] This is in contrast to Milerad et al. [5] and Chan et al. [16] who found VSD to be the predominant CHD. None of the lesions were serious enough to defer surgery, but their diagnosis will aid the prevention of complications like infective endocarditis, which has a higher rate in small VSD, primum ASDs and multiple defects. [18]

The relatively high rate of CHD among children with oral clefts in this study justifies the need for ECGS for these categories of children, not necessarily before corrective surgery, but to diagnose CHD early in life so as to manage any life-threatening CHD appropriately.

 
  References Top

1.Cooper ME, Ratay JS, Marazita ML. Asian oral-facial cleft birth prevalence. Cleft Palate Craniofac J 2006;43:580-9.  Back to cited text no. 1
    
2.Vanderas AP. Incidence of cleft lip, cleft palate, and cleft lip and palate among races: A review. Cleft Palate J 1987;24:216-25.  Back to cited text no. 2
    
3.Croen LA, Shaw GM, Wasserman CR, Tolarová MM. Racial and ethnic variations in the prevalence of orofacial clefts in California, 1983-1992. Am J Med Genet 1998;79:42-7.  Back to cited text no. 3
    
4.Iregbulem LM. The incidence of cleft lip and palate in Nigeria. Cleft Palate J 1982;19:201-5.  Back to cited text no. 4
    
5.Milerad J, Larson O, PhD D, Hagberg C, Ideberg M. Associated malformations in infants with cleft lip and palate: A prospective, population-based study. Pediatrics 1997;100:180-6.  Back to cited text no. 5
    
6.Aimede OS, Olalere GO, Adedayo O, Adeshola S. Orofacial clefts: Our experience in two suburban health facilities. Dentistry 2013;3:155.  Back to cited text no. 6
    
7.Otaigbe B, Akadiri O, Eigbobo J. Clinical and echocardiographic findings in an African pediatric population of cleft lip/palated patients: A preliminary report. Niger J Cardiol 2013;10:6-8.  Back to cited text no. 7
    
8.Geis N, Seto B, Bartoshesky L, Lewis MB, Pashayan HM. The prevalence of congenital heart disease among the population of a metropolitan cleft lip and palate clinic. Cleft Palate J 1981;18:19-23.  Back to cited text no. 8
    
9.Liang CD, Huang SC, Lai JP. A survey of congenital heart disease in patients with oral clefts. Acta Paediatr Taiwan 1999;40:414-7.  Back to cited text no. 9
    
10.Barbosa MM, Rocha CM, Katina T, Caldas M, Codorniz A, Medeiros C. Prevalence of congenital heart diseases in oral cleft patients. Pediatr Cardiol 2003;24:369-74.  Back to cited text no. 10
    
11.Rawashdeh MA, Jawdat Abu-Hawas B. Congenital associated malformations in a sample of Jordanian patients with cleft lip and palate. J Oral Maxillofac Surg 2008;66:2035-41.  Back to cited text no. 11
    
12.Sun T, Tian H, Wang C, Yin P, Zhu Y, Chen X, et al. A survey of congenital heart disease and other organic malformations associated with different types of orofacial clefts in Eastern China. PLoS One 2013;8:e54726.  Back to cited text no. 12
    
13.Grosen D, Chevrier C, Skytthe A, Bille C, Mølsted K, Sivertsen A, et al. A cohort study of recurrence patterns among more than 54,000 relatives of oral cleft cases in Denmark: Support for the multifactorial threshold model of inheritance. J Med Genet 2010;47:162-8.  Back to cited text no. 13
    
14.Shafi T, Khan MR, Atiq M. Congenital heart disease and associated malformations in children with cleft lip and palate in Pakistan. Br J Plast Surg 2003;56:106-9.  Back to cited text no. 14
    
15.Wyse RK, Mars M, al-Mahdawi S, Russell-Eggitt IM, Blake KD. Congenital heart anomalies in patients with clefts of the lip and or palate. Cleft Palate J 1990;27:258-64.  Back to cited text no. 15
    
16.Chan KW, Lee KH, Pang KK, Mou JW, Tam YH. Clinical characteristics of children with orofacial cleft in a tertiary centre in Hong Kong. Hong Kong J Paediatr 2013;18:147-51.  Back to cited text no. 16
    
17.Altunhan H, Annagür A, Konak M, Ertuðrul S, Ors R, Koç H. The incidence of congenital anomalies associated with cleft palate/cleft lip and palate in neonates in the Konya region, Turkey. Br J Oral Maxillofac Surg 2012;50:541-4.  Back to cited text no. 17
    
18.Shet A. Infective endocarditis in congenital heart diseases. In: Rao PS, Chugh R, editors. A Comprehensive Approach to Congenital Heart Diseases. 1 st ed. New Delhi: Jaypee Brothers Medical Publishers; 2013. p. 995-1003.  Back to cited text no. 18
    



 
 
    Tables

  [Table 1], [Table 2]


This article has been cited by
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Brazilian Oral Research. 2018; 32(0)
[Pubmed] | [DOI]



 

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