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brief report
Ann Saud Med 27(6) Novembe-Decembe 2007
www.kfshrc.edu.sa/annals 
442
he word ‘prevalence’ o congenial hear disease(CHD) usually means he esimaed populattion o people wih CHD a any given ime.Te erm ‘incidence’ o CHD means he annual diagnottsis rae or he number o new cases o CHD diagnosedeach year. Mos o he recen sudies in he Gul regionmeasured he incidence o CHD in children.
1,2
Tereare various local sudies on he paern o CHD,
3,4
andhese sudies are descripive analyses o a seleced samttple. Our sudy is he rs communiytbased naionalprevalence sudy o sympomaic CHD in children andadolescens in Saudi Arabia, and includes CHD prettsening wih sympoms or clinical signs. Excluded areasympomaic paen ducus areriosus in he rs 3monhs o lie; simple bicuspid aoric valves; isolaedperipheral pulmonary arery senosis wih no clinicalsignicance; and minor arial shuns across deecsmeasuring less han 5 mm.
Methods
Our sudy was par o he Healh Prole o he SaudiChildren and Adolescens Projec. Te sample was
Symptomatic congenital heart disease in theSaudi Children and Adolescents Project
Mansour Alqurashi,* Mohammad El Mouzan,† Abdullah Al Herbish,† Abdullaha Al Salloum,† Ahmad Al Omer‡
From the *Department of Pediatrics, Al-Yamamah Hospital, Riyadh, Saudi Arabia, †Department of Pediatrics,The College of Medicine, KingSaud University, Saudi Arabia, and ‡The Children’s Hospital, Riyadh Medical Complex, Saudi ArabiaCorrespondence and reprint requests: Mansour Al Qurashi, FRCP · Al-Yamamah Hospital · PO Box 60989 · Riyadh 11555 · Saudi Arabia · T:+966-1-491-4444 Ext: 1147/4030 · F:+966-1-208-3060 · m2_qurashi@hotmail.com · Accepted for publication May 2007Ann Saudi Med 2007; 27(6): 442-444
45 682 children and adolescens o ages rom birho 19 years seleced by mulisage probabiliy randomsampling o Saudi households rom a sraied lisingbased on he populaion census o he 13 regions o he counry including major ciies, small owns and vilttlages. A housetothouse visi by he eld eam, whichincluded a physician, was made o all he households inhe sample. A quesionnaire ha included age, gender,medical hisory and physical examinaion was completted. Te resuls o he inerview and clinical examinattion allowed classicaion o he children ino one o he ollowing caegories:a) Children wih a known diagnosis o CHD, conttrmed wih medical repors and echocardiographyresuls rom he concerned hospials. Tese childrenwere classied according o diagnosis ino 4 groups(able 1).b) Children wih a known diagnosis o CHD buwihou supporing medical repors rom concernedhospials. Te diagnosis was based on wha he amittlies were old abou echocardiography resuls by reatting docors. Tese children were labeled as unspeciedcongenial hear disease (able 1).c) Children wih a hisory and clinical signs suggestting cardiac disease ha were no diagnosed beore, whowere reerred o hospials. Te hospial diagnosis wasbased on clinical examinaion and echocardiography.Tese children were included in he sudy aer he dittagnosis was provided by local hospials and classied ascaegory (A) ino 4 groups.
Results
During he period 2004t2005, o a oal o 45 682 chilttdren and adolescens, 95 had CHD or a prevalence o 21 per 10 000. Te ypes o diseases are shown in able1. Venricular sepal deec (VSD) was he commonesdiagnosis, occurring in 44 o he 95 (46.3%) childrenwih CHD wih he highes prevalence o 10 per 10 000.
Table 1.
Pevaence o conenta heat dseases n Saud chden.
DiseasesNumber of casesPrevalence per10 000MalesFemalesTotal (%)
Ventcuaseptadeect182644 (46)10Ataseptadeect268 (8.5)2Othenon-canotc CHD*347 (7.5)2Canotc CHD†5510 (11)2Unspecfed CHD141226 (27)6TotaCHD425395 (100)21
*Patent ductus ateosus 1, coactaton o the aota 1, aotc stenoss 2, pumona stenoss 2 and Ebsten’s anoma1. †Tetao o Faot 3, tansposton o eat atees 2, compex canotc heat dsease 5.
 
brief report
SyMPTOMATiC CONgENiTAl HEArT DiSEASE
Ann Saud Med 27(6) Novembe-Decembe 2007
www.saudiannals.net 
443
Te nex mos common group was unspecied CHDin 26 o 95 (27.4%) or a prevalence o 6 per 10 000.Te remainder o he cases, such as cyanoic CHD,arial sepal deecs (ASD), and oher nontcyanoicCHD occurred much less commonly wih a prevalenceo abou 2 per 10 000 each.Te disribuion o CHD according o sex o pattiens showed a sligh predominance in emales, wih53 girls and 42 boys, or a emale o male raio o 1.3:1 (able 1). VSD was slighly more common inemales wih a emale o male raio o 1.4:1. ASD wasseen more in girls wih a emale o male raio o 3:1.Cyanoic CHD was equal in boh sexes.Te regional disribuion o CHD showed hahe Cenral Region had he highes prevalence o 27per 10 000, ollowed by he Norhern and he EasernRegions, wih a prevalence o 25 per 10 000 each andhe Souhwesern Region prevalence o 21 per 10 000.Te prevalence was less common in he norhwesernregion, wih 10 children only (prevalence 9 per 10 000).o assess he prevalence o CHD more accuraely, heresuls were relaed o sample size in each region: NorhWesern Region (Makkah and Madinah regions)=10711, Cenral Region (Riyadh and Qassim regions)=11194, Easern Region (Damam region)=4420, NorhernRegion (Jou, Norhern Border, Hail and abuk rettgions)=8 959, and he Souhwesern Region (Assir,Gizan, Najran and Al Baha regions)=10 398.
discussion
Te prevalence o CHD in Saudi children is comparedwih oher sudies in able 2. Te prevalence in oursudy was lower han in hospialtbased sudies due ovariaions in mehods and age diferences,
5t7
whereashe prevalence was higher han in schooltbased sudtties due o age diferences.
8t10
Te prevalence o CHDis relaed o he relaive requency o VSD,
11
he moscommon ype o CHD.
12t13
Te majoriy o VSD areclosed sponaneously in early childhood,
8,9,14
so heprevalence o CHD in his communiytbased sudy(which includes a wide age range) was expeced o belower han in hospialtbased sudies, which are doneusually in inans or newborns.
5t7,13
Te prevalence o CHD also depends on he diagnosis o minor cardiacdeecs such as small arial sepal deec, small patten ducus areriosus, and mild pulmonary valve settnosis.
11,15t17
Tese minor lesions were no diagnosedin his communiy sudy due o suble clinical signs.Mos newborns wih severe ypes o complex cardiaclesions die beore 1 year o age, which also reduces heprevalence o CHD in older children.
5,7,9,14
Tese acttors explain he low prevalence o CHD in his sudy incomparison wih hospialtbased sudies.
6,7
 Our sudy showed a low prevalence o CHD comttpared wih similar communiytbased sudies in ohercounries such as China and India, which is eiher dueo acual low prevalence in Saudi Arabia or undertrett
Table 2.
Pevaence o conenta heat dsease n chden and adoescents wodwde.
Study descriptionPrevalence per10 000 populationChildrenNumberYearAgePlace Of Study
Communt-basedstud2145 6822005Bth - 18 sSaud Aaba(pesent stud)Popuaton-basedstud37439019930-1eaUSA: Batmoe-Washnton inantStud
7
Popuaton-basedstud47330 0172003lve and stbthsita: Ema-romana rest,Cazoa E
6
Popuaton-basedstud61815 56919990-15 easCzech repubc:Bohema Suvva Stud,Samanek M
5
Schoo-basedstud10178820005-15 easEpt: Aexanda, Zak
9
Schoo-basedstud2013 32219975-15 easSudan: Sahaa Town, Kha
10
Schoo-basedstud13942020035-18 easNepa: Kathmandu, Bahadu
8
Communt-basedstud4211 83320010-15 easinda: New Deh, Chadha Sl
18
Communt-basedstud5048 63820053-18 easChna: yunnan Povnce, Jan
19
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