|
 
 |
| ORIGINAL ARTICLE |
|
| Year : 2022 | Volume
: 25
| Issue : 3 | Page : 86-88 |
|
Review of Echocardiographic reports of children undergoing noncardiac surgery in a tertiary health center in Nigeria
Mustafa O Asani1, Ibrahim Ahmadu2, Nuhu Abubakar Garba3, Muhammad Shakur Abubakar2, Apollos Daniel4, Ibrahim Aliyu1
1 Department of Paediatrics, Bayero University Kano, Aminu Kano Teaching Hospital, Kano, Nigeria
2 Department of Paediatrics, Aminu Kano Teaching Hospital, Kano, Nigeria
3 Department of Paediatrics, Federal medical Centre Nguru, Nguru, Nigeria
4 Department of Paediatrics, Federal Teaching Hospital, Gombe, Nigeria
| Date of Submission | 22-Nov-2020 |
| Date of Decision | 20-Jan-2021 |
| Date of Acceptance | 12-Mar-2021 |
| Date of Web Publication | 20-Nov-2023 |
Correspondence Address:
Dr. Ibrahim Aliyu
Department of Paediatrics, Aminu Kano Teaching Hospital, Kano
Nigeria
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/smj.smj_158_20
Background: The risk of cardiac anomalies, both acquired and congenital, is high in children undergoing noncardiac surgeries. These cardiac anomalies are associated with increased risk of perioperative complications. Objectives: This study, therefore, determined the common indications as well as the echocardiographic findings findings in children undergoing noncardiac surgery in Aminu Kano Teaching Hospital (AKTH), Kano. Materials and Methods: This is a retrospective descriptive study. The echocardiographic records of 25 children that underwent noncardiac surgery in AKTH over a 4 year period (from January 2015 to December 2018) were retrieved. The data obtained were analyzed using SPSS version 20 and the result was displayed using a frequency distribution table and bar chart. Results: There were 14 males and 11 females, with male to female ratio of 1.3:1. The ages of the patients range from 5 days to 8 years (median age of 8 months). The most common indication for echocardiography is orofacial cleft (cleft lip and/or palate), followed by adenotonsillar hypertrophy. The overall cardiac anomaly was found in 28% of the patients, with the highest anomaly being the atrial septal defect. Conclusion: The prevalence of cardiac anomaly was high in children with noncardiac surgical conditions.
Keywords: Children, echocardiography, noncardiac surgery, North-Western Nigeria
How to cite this article:
Asani MO, Ahmadu I, Garba NA, Abubakar MS, Daniel A, Aliyu I. Review of Echocardiographic reports of children undergoing noncardiac surgery in a tertiary health center in Nigeria. Sahel Med J 2022;25:86-8 |
How to cite this URL:
Asani MO, Ahmadu I, Garba NA, Abubakar MS, Daniel A, Aliyu I. Review of Echocardiographic reports of children undergoing noncardiac surgery in a tertiary health center in Nigeria. Sahel Med J [serial online] 2022 [cited 2023 Dec 6];25:86-8. Available from: https://www.smjonline.org/text.asp?2022/25/3/86/389942 |
| Introduction | |  |
Children with disease conditions requiring noncardiac surgical interventions may have co-existing congenital or acquired heart diseases.[1] It was estimated that approximately 1 in 150 children have congenital heart disease (CHD), out of which a quarter of these children have an additional noncardiac defect.[1] Children with noncardiac congenital anomalies may have an increased risk for CHD.[2] Asani and Aliyu in Kano, North-western Nigeria reported the prevalence of CHD in children with orofacial cleft as 20%.[3] Oyati et al. in Zaria found abnormal echocardiographic scan in 35% of children with surgically correctable noncardiac congenital anomalies.[4] In a similar study by Sadoh et al. in Benin, Nigeria, the prevalence of cardiac abnormalities from echocardiography was found to be 21.5% among children undergoing noncardiac surgeries.[5] These cardiac anomalies may pose an increased risk for perioperative complications, hence the need for preoperative cardiovascular evaluation to identify patients at risk of major adverse outcomes.[5],[6] In principle, the preoperative cardiovascular evaluation should be performed using noninvasive techniques including echocardiography.[7]
This study is therefore designed to review the echocardiographic reports of children undergoing noncardiac surgery in Aminu Kano Teaching Hospital (AKTH), Kano, North-western Nigeria.
Specific objectives
- To determine the common indications for echocardiography in children undergoing noncardiac surgery in AKTH
- To determine the common echocardiographic findings in children undergoing noncardiac surgery in AKTH.
| Materials and Methods | | |
This is a retrospective descriptive study of the echocardiographic records of all children undergoing noncardiac surgery in AKTH over 4 years (January 2015 to December 2018). These children were referred to the cardiopulmonary clinic for assessment before the surgery from various units including maxillofacial unit (MFU), ENT, ophthalmology, etc. The children had clinical assessment as well as transthoracic echocardiography by the pediatric cardiologists using ALOKA SSD and SonoScape SSI– 8000 ultrasound systems. Approval of the Research ethics committee of AKTH was obtained before this study (NHREC/28/01/2020/AKTH/EC/2891).
The data obtained from the echocardiographic records include the age and gender of the patients, the indications for the echocardiography as well as the echocardiographic findings. Patients with incomplete records were excluded from the study.
Statistical analysis
The data collected were coded, entered, and analyzed using the Statistical Package for the Social Sciences for Windows version 20 (IBM Corp., Armonk, NY, USA). The age of the patients was summarized using median and range, while categorical variables were summarized using frequency distribution tables and bar chart.
| Results | | |
Echocardiographic records of 25 patients undergoing various surgeries were reviewed. There were 14 males and 11 females, giving a male to female ratio of 1.3:1. The ages of the patients range from 5 days to 8 years with a median age of 8 months. [Table 1] summarizes the various indications for echocardiography. Most of the patients were referred from the maxillofacial unit with orofacial cleft (cleft lip and/or palate) which accounted for 64% of all the cases. Isolated cleft lip accounted for 44% of the cases, followed by adenotonsillar hypertrophy which accounted for 16% of the cases.
[Figure 1] summarizes the echocardiographic findings in the patients. Seven (28%) of the patients had abnormal echocardiography. Among the patients with abnormal echocardiographic findings, three patients had atrial septal defect (ASD) accounting for 42.9%. Other findings include dilated cardiomyopathy (DCM), ventricular septal defect (VSD), and Cor pulmonale which accounted for 28.6%, 14.3%, and 14.3% respectively.
A total of 16 patients with orofacial cleft (cleft lip and/or palate) had echocardiography, out of which 4 (25%) had cardiac anomalies. These are ASD (2), VSD (1), and DCM (1).
| Discussion | | |
Children with heart diseases requiring noncardiac surgery may pose challenge to anesthetists. It is, therefore, important to evaluate for cardiac anomalies before surgery, in order to anticipate the effects of these anomalies on cardiac output or oxygen saturation during surgery.[1] In this study, cardiac anomalies were found in 28% of the children that had echocardiography. This prevalence is slightly higher than that of Sadoh et al. in Benin who reported prevalence of 21.5%.[5] The difference in the prevalence may be as a result of higher sample size in the Benin study. However, the prevalence in this study is lower than that of Oyati et al. in Zaria who reported a prevalence of 35%.[4] The study by Oyati et al. also has a higher sample size than our study.
Most of the patients that had echocardiography during the period of our study had orofacial cleft with isolated cleft lip being commonest, accounting for 44% of all the cases. This finding is similar to that of Oyati et al. who reported 38.3% and that of Sadoh et al. who reported 48.1%.[4],[5]
The atrial septal defect was the most common cardiac anomaly found in our study which accounted for 42.9% of all the cardiac anomalies. This is in keeping with previous studies that reported ASD as the most common cardiac anomaly among children undergoing noncardiac surgeries.[4],[5],[8] ASD was found to be the most common cardiac anomaly among children with orofacial cleft in our study. This finding is similar to that of a previous study from this facility by Asani and Aliyu and that of Sadoh et al. in Benin.[3],[5] However, our findings differ with that of Otaigbe et al. in Port Harcourt, Nigeria, and Kasatwar et al. in Wardha, India, who found VSD to be the most common cardiac anomaly in patients with cleft lip and palate.[9],[10]
Cardiomyopathy is a major cause of sudden, unexpected death in children undergoing noncardiac surgeries.[1] In our study, two patients were found to have DCM which accounted for 28.6% of all the cardiac abnormalities.
| Conclusion | | |
This study shows that the prevalence of cardiac anomaly is high in children undergoing noncardiac surgery in AKTH, Kano. It is similar to the findings from previous researches. Therefore, the practice of cardiovascular assessment including echocardiography before surgery in patients with noncardiac surgical conditions should continue.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Moriarty A, Jacobs A, James I. Anaesthesia for children with heart disease undergoing non-cardiac surgery. In: James I, Walker I, editors. Core Topics in Paediatric Anaesthesia. Cambridge University Press; 2013. p. 322-34.  |
| 2. | Ekure EN, Animashaun A, Bastos M, Ezeaka VG. Congenital heart diseases associated with identified syndromes and other extra-cardial congenital malformations in children in Lagos. West Afr J Med 2009;28:323-237. |
| 3. | Asani MO, 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. [Full text] |
| 4. | Oyati AI, Danbauchi SS, Ameh EA, Mshelbwala PM, Anumah MA, Ogunrinde GO, et al. Echocardiographic findings in children with surgically correctable non-cardiac congenital anomalies. Ann Trop Paediatr 2009;29:41-4. |
| 5. | Sadoh WE, Ikhurionan P, Imarengiaye C. Pre-anesthetic echocardiographic findings in children undergoing non-cardiac surgery at the University of Benin Teaching Hospital, Nigeria. Cardiovasc J Afr 2016;27:276-80. |
| 6. | McMartin K. Preoperative resting echocardiography for noncardiac surgery: a rapid review. Health Quality Ontario; 2014; p. 1-17. |
| 7. | Kyo S, Imanaka K, Masuda M, Miyata T, Morita K, Morota T, et al. Guidelines for perioperative cardiovascular evaluation and management for noncardiac surgery (JCS 2014). Circ J 2017;81:245-67. |
| 8. | Wammanda RD, Danbauchi SS. An echocardiography analysis of paediatric cardiac diseases. Trop Cardiol 2002;110:29-31. |
| 9. | Otaigbe BE, Akadiri OA, Eigbobo JO. Clinical and echocardiographic findings in an African pediatric population of cleft lip/palate patients: A preliminary report. Niger J Cardiol 2013;10:6-8. |
| 10. | Kasatwar A, Borle R, Bhola N, Rajanikanth K, Prasad GS, Jadhav A. Prevalence of congenital cardiac anomalies in patients with cleft lip and palate – Its implications in surgical management. J Oral Biol Craniofac Res 2018;8:241-4. |
[Figure 1]
[Table 1]
|
Search Pubmed for