1、Congenital heart malformation:Prevalence,severity,survival,and quality of life先天性心脏病流行病学先天性心脏病流行病学The lowest values/1000 live birthsAuthor Region Fyler 2.10 New England,USAGardiner 2.17 Toronto,CanadaAkman 3.20 Bogalusa,USAMacMahon 3.20 Birmingham,UKMckeown 4.20 Birmingham,UKBosi 4.60 ItalyBierman 4
2、.70 HawaiiPrevalence of congenital heart malformation at birththe highest values/1000 births author Region Fischer 8.20 Tyrol,AustriaKerrebijn 8.26 Leiden ,NetherlandGrech 8.80 MaltaHoffmann 8.82 San Francisco,USAMeberg 9.02 NorwayNakazawa 10.00 JapanManetti 12.30 Florence,ItalyYerushalmi 11.70 Cali
3、fornia,USAPrevalence of congenital heart malformation at birthThe oldest surveys/1000 live birthsAuthor Date Prevalence()Macmahon 194049 3.23Carlgren 1941 50 6.35Harris 194450 5.90Pleydell 194457 3.20Landtman 1945 63 8.00Richards 194653 5.50Gardiner 194849 2.17Mustachi 194951 5.88Prevalence of conge
4、nital heart malformation at birthRecent data/1000 live birthsAuthor Date Prevalence()Grech 1990-94 8.80Robida 1984-94 12.23Bosi 1992-93 4.60Anderson 1987-90 10.20Cerboni 1988-90 6.08Ferencz 1981-89 4.23Pexieder 1986-87 6.04Meberg 1982-88 9.02Prevalence of congenital heart malformation at birthPreval
5、ence of congenital heart malformation at birthRegional differences/1000 live birthsRegion Mean Range difference place Europe 6.67 3.20 Birmingham,UK 12.30 Florence,ItalyUSA 5.76 3.20 Bogalusa 8.56 San FranciscoCanada 3.97 2.17 Toronto 5.54 AlbertaOther countries 8.97 6.08 Guadeloupe Yearly fluctuati
6、on in Bohemian data from 1980 through 1989Year No.of malformation Prevalence/10001980 646 7.041981 547 6.391982 568 6.771983 548 6.731984 566 6.971985 495 6.161986 436 5.531987 455 5.821988 402 5.111989 367 4.80 Prevalence of congenital heart malformation at birth The prevalence was highest in Octob
7、er,and lowest in December,June and July.The peak of the prevalence coincided with the epidemics of influenza in early pregnancy 8 and 9 months previously.There was a definite seasonal variationRatio of boys to girlsBoys to girls with CHD:51.9%to 48.1%A higher proportion of boys was found with:DORV(2
8、.68:1);HLHS(2.25:1)cTGA (2.11:1);A higher proportion of girls was found with:PDA(1:1.66);Ebsteins malformation(1:1.57)Common arterial trunk(1:1.22)Distribution of congenital heart malformationVSD 41.59%ASD 8.67%Aortic stenosis 7.77%Pulmonary stenosis 5.81%cTGA 5.39%Aortic coarctation 5.29%PDA 5.07%G
9、reater than 5%of the overall number of malformationDistribution of congenital heart malformation AVSD 4.00%HLHS 3.42%TOF 3.36%DORV,common arterial trunk and pulmonary atresia 1.05-1.37%TAPVC 0.80%Tricuspid 0.78%Ebstein malformation 0.44%Interrupted aortic arch 0.44%Spontaneous closure in 576 of 2092
10、 recognized ventricular Septal defects,accounting for 27.5%of the casesCritical heart malformation in neonates,10 most frequent Number proportion of total Malformations number seen(%)cTGA 102 84Pul atresia 39 74Coarctation 34 49HLHS 34 94Tricuspid atresia 13 77DORV 20 50VSD 8 8Common AT 8 50TOF 7 28
11、Critical heart disease:which threaten life,which manifested by severve Congestive heart failure,deep cyanosis,or both symptomsDeath rate of children born with CHDSurvival in most frequent cardiac malformation CHD Number survival(%)at age of 1 5 15yrsVSD 2097 91 90 89ASD 436 94 93 93Aortic stenosis 3
12、91 90 89 88PS 292 96 96 96cTGA 271 62 56 54Coarctation 266 68 65 65PDA 255 91 91 91AVSD 201 62 55 54HLHS 172 0 0 0TOF 169 84 78 77Questionnaires,1564例例8-13岁岁先心病患儿生存先心病患儿生存质量调查质量调查 83.2%未用任何药未用任何药 3.2%体能差体能差 59.5%可参加娱乐消遣性活动可参加娱乐消遣性活动 6.7%可参加竞争性的运动可参加竞争性的运动 35.5%上学延迟上学延迟 6.9%学习差学习差 身高及体重与同龄人无区别身高及体重与同龄人无区别 先心病儿给父母造成心理紧张先心病儿给父母造成心理紧张生活质量生活质量
