title: Challenges on the management of congenital heart disease in developing countries.
abstract: BACKGROUND
  While in developed countries prenatal diagnosis is currently used to detect Congenital Heart Disease before (CHD) before birth, in developing countries only a minority of children with CHD is detected and few benefit from surgical treatment. Having created a referral unit for diagnosis and treatment of cardiovascular diseases in a resource-deprived country we designed a study aiming at describing the spectrum and characteristics of CHD and discuss the challenges of its management.
  
  
  METHODS
  We studied retrospectively all patients assisted at a referral unit between 2001 and 2007, collecting epidemiological, clinical, echocardiographic and surgical data from hospital files.
  
  
  RESULTS
  We studied 534 patients with median age at diagnosis of 4 years (range 0-79); 296 were females (55.4%). Only 282 (52.8%) patients were diagnosed under the age of two years, and complications were present in 155 (29.0%) at time of diagnosis. We operated 196 patients with mean age of 8±10 years. Only 29 of the 111 complex defects were considered for surgery. The 30-days post-operative mortality was 8/196 (4.0%). The most important post-surgical complications were post pericardectomy syndrome (22).
  
  
  CONCLUSIONS
  A pattern of late presentation accompanied by high rate of complications was found. In resource-deprived settings the approach to the management of CHD emphasizes the treatment of "curable" malformations. Surgery for CHD in these settings must be linked to early detection and a referral system in which general practitioners, pediatricians, obstetricians and cardiologists interact in the design and implementation protocols for diagnosis, management and follow-up of patients.
authors.affiliation: Instituto do Coração, Mozambique. amocumbi@yahoo.com
authors.forename: Ana Olga
authors.initials: AO
authors.lastname: Mocumbi
authors.forename: Elsa
authors.initials: E
authors.lastname: Lameira
authors.forename: Ameeta
authors.initials: A
authors.lastname: Yaksh
authors.forename: Louis
authors.initials: L
authors.lastname: Paul
authors.forename: Maria Beatriz
authors.initials: MB
authors.lastname: Ferreira
authors.forename: Daniel
authors.initials: D
authors.lastname: Sidi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries / Q000191:economics*; D019468:Disease Management; D005260:Female; D006330:Heart Defects, Congenital / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009073:Mozambique / Q000453:epidemiology; D012189:Retrospective Studies; D055815:Young Adult