Clinical profile of adult patients referred to congenital heart surgery in Egypt, a single center experience.

Abstract

Background A major challenge facing adult congenital heart disease (ACHD) service in developing countries is the lack of adequate data on the disease burden and specific needs of this group. We aimed to describe ACHD patients in Egypt who are in need for further surgical correction, their various presentations, and the types of surgeries required. Methods The study included ACHD patients considered for further surgical correction after a heart team discussion at a tertiary cardiac center in Egypt. Data about age, gender, presentation, functional capacity, resting oxygen saturation, diagnosis, previous intervention and its timing, and the type of surgery decided were collected. Results Over one year, 103 cases (49.5% males, mean age 23 years) were referred to surgery out of 134 cases discussed at the heart team committee. One-third of the patients (34%) were cyanotic and the majority presented in NYHA functional class II (44.7%) and III (35.95%). More than half of the patients (56.3%) had a previous surgical or trans-catheter intervention with a median age of 4 years at the time of the first procedure. The most frequently encountered diagnoses were: Tetralogy of Fallot (ToF) (23.3%), atrial septal defect (18.4%), double outlet right ventricle (DORV) (11.6%), and transposition of great arteries (TGA) (7.8%). Surgical procedures that were required most were: Fontan procedure (20.3%), surgical ASD closure (18.4%), surgical pulmonary valve replacement (14.5%), total ToF repair (9.7%), subaortic membrane resection (6.7%) and tricuspid valve surgery (5.8%). Conclusions The group of ACHD patients in Egypt who require further surgical correction is heterogeneous with various presentations and needs. The required surgeries vary from simple to complex procedures. An efficient ACHD program necessitates the collaboration of dedicated cardiologists, radiologists, and cardiothoracic surgeons who are familiar with the unique demands and difficulties of this patient group.