The burden of Fallot's tetralogy among Nigerian children

Abstract

Background: There are only very few reports on Fallot's tetralogy in Africa especially from sub-Saharan Africa. At best tetralogy of Fallot (TOF) is only mentioned as part of reports of surveys of other congenital heart diseases or as case reports in the region. There has been no report on cohorts of children with TOF in West Africa. This article describes the pattern and presentation of children diagnosed with TOF patients in a tertiary hospital in sub-Saharan Africa over a 9-year period.

Methods: Prospective and consecutive review of all subjects with diagnosis of TOF confirmed with echocardiography at the Lagos State University Teaching Hospital (LASUTH) between January 2007 and December 2015. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics were presented as percentages or means and standard deviation. Means of normally distributed variables were compared using the Students' t-test and proportions using Chi-square test. Skewed distributions were analyzed using appropriate non-parametric tests. Level of significance set at P<0.05.

Results: The prevalence of TOF among children presenting at LASUTH at the study period was 4.9 per 1,000 while its prevalence among those with congenital heart disease was 16.9%. There was a male predominance with a mean age of 50.9±45.9 (months) and median age of 36 months. Most children presented within 1-5 years of age. The most common indication for evaluation was cyanosis. One hundred and nineteen out of 165 (72.1%) children were clinically cyanosed on presentation.

Conclusions: TOF is prevalent among Nigerian children. Cyanosis was the commonest presenting feature and indication for evaluation. Most of the subjects presented late hence were diagnosed after 1 year of age. There is a need to increase awareness of TOF in Nigeria to encourage early diagnosis and hence better outcomes in these subjects.

Keywords: Children; burden; congenital; cyanosis.

Figure 1

Parasternal long axis view of a representative echocardiographic image of a patient with tetralogy of Fallot showing dilated aortic root, biventricular hypertrophy, large ventricular septal defect and an overriding aorta.