الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Congenital heart disease (CHD) is the commonest of all congenital lesions and is the most common type of heart disease among children. The incidence of congenital heart disease is approximately 8 per 1000 live birth, with a higher rate in stillbirth, spontaneous abortion and prematurity.
The cause of most Congenital heart defects is unknown. Most cases of congenital heart disease are thought to be multifactorial and result from a combination of genetic predisposition and environmental stimulus.
Congenital cardiac defects can be divided into two major groups based on presence or absence of cyanosis into cyanotic and acyanotic, which can be determined by physical examination. These two groups can be further subdivided according to whether the chest radiograph shows evidence of increased, normal or decreased pulmonary vascular markings. The final diagnosis is confirmed by echocardiography or cardiac catheterization.
Knowing relative frequency, manifestations and how to manage each type of CHD may help in planning of detection, treatment and rehabilitation of those suffering from CHD.
The aim of the work was to assess the magnitude of the problem of congenital heart disease in Alexandria by estimation of the frequency and clinical profile of each type of CHD in the main two hospital dealing with such cases the Student’s Health Insurance hospital and the University Children’s Hospital to find and improve the
management and health care service to them.
In our study, the target population was three hundred cases attending the outpatient clinic of the former hospitals; one hundred and fifty patients from each one. Their age group ranged from 2-12 years and both sex were involved.
All the studied patients were subjected to the following:
1- Full history and clinical examination according to a questionnaire of the outpatient clinic was taken.
2- Full echocardiographic evaluation including 2dimensional, M-mode, and Doppler both pulsed and continuous. Cardiac catheterization was performed when indicated.
The data were analyzed using SPSS program with the following results:
• Total number of the studied cases were 300 cases; (52.7%) were females and
(47.3%) were males.
• Age of the studied cases were 2 -12 years; there were (65%) of cases aged 2-5 years, (20.3%) were 5-10 years and (14.7%) of cases were 10-12 years.
• (18.3%) of all studied cases were cyanotic CHD, while (81.7%) were acyanotic
CHD.
• The most important risk factors are; paternal consanguinity, presence of family history of other congenital heart disease and associated any other congenital anomalies or chromosomal abnormalities.
• There are other important environmental – non hereditary – risk factors for occurrence of congenital heart disease especially on maternal exposure in the first trimester of pregnancy as: Maternal infection, Maternal exposure to smoking, Maternal exposure to chemicals, Maternal exposure to psychological or physical stress, Maternal chronic illness especially diabetes, hypertension,
epilepsy, Maternal drug intake especially female sex hormone, anti-epileptic, anti-diabetics and anti-hypertensive, Maternal exposure to irradiation
• VSD was the commonest type of CHD; its frequency was (31.3%). TOF was the commonest cyanotic CHD and its frequency was (9.7%).
• According to presenting picture, VSD most commonly presented by repeated chest infection and heart manifestations, (44%) of ASD cases presented accidently, for AVSD, (51.2%) presented by repeated chest infection and (37.2%) by heart manifestations, while the most frequent diagnosis represented
by cyanosis was TOF then TGA.
• The respiratory complications were the most common complication; the repeated chest infection was (59.7%) of the studied cases, and the pulmonary hypertension was (19.7%) of all cases while heart failure was (27.7%), while (2%) of cases had infective endocarditis and (1.3%) of cases had arrhythmia.
• Fifty cases underwent cardiac catheterization, from them 43 cases were diagnostic catheter while only 7 cases were interventional therapeutic catheter; they were aterial septostomyand balloon pulmonary valvuloplasty in our study.
• Regarding the natural history and progress of our cases we found; (3.3%) of our cases had been spontaneously cured, (49%) were clinically stable and they were on follow up, (32.3%) of cases were on medical treatment, (19.3%) underwent
to cardiac surgery while (26%) of cases were waiting for surgery and (2.3%)
underwent interventional cardiac catheter.