| Objective First,to further assure the incidence of congenital heart disease,the morbid situation and its constitution ratio,etc by taking Ultrasonocardiography(ECHO) tests on infants who are 2 to 5 days after their birth,born in KiangWu Hospital of Macao in one year's period so as to know the heart structure anomaly situation and by carrying regular follow-ups to infants with abnormal heart structure.Second,to evaluate the effectiveness of corresponding intervene actions taken to those congenital heart disease(CHD) infants with intervene indication and the regular follow-ups.Third,to analyze the high-risk factors of prevalence CHD.Through this research,incidence situations of CHD in Macao can be known and scientific reference can be provided for monitoring,intervening and follow-ups.Also,this research can also serve as a referral source for other localities in preventing and controlling congenital heart disease.Methods Taking Ultrasonocardiography(ECHO) tests on 2124 infants when they were 2 to 5 days after birth,in KiangWu Hospital,Macao during June 1st,2006 to May 31,2007.The same test would be undertaken to anyone found abnormal in heart structure when it was 1-2 months old and 4-6 months old,mainly to see PDA and the opening and closing situations of ASD. Corresponding interventions were taken and regular follow-ups were paid on those congenital heart disease(CHD) infants with intervene indication.High-risk factor of CHD were collected. The statistic analysis was accomplished with SPSS 13.0 software.Results1.305 cases of new-born infants with abnormal heart structure were found from June 1st, 2006 to May 31,2007,by Ultrasonocardiography(ECHO) test taken on 2124 two-to-five-days-born infants born in KiangWu Hospital,Macao.136 cases were male infants were(44.6%) while female infant were 169 cases(55.4%).Different abnormal heart structure were found as:(1) 171 cases(56.1%) of diagnosed as PDA,(2) 81cases(26.6%) were diagnosed as ASD/PFO,(3) 29cases(9.5%) were diagnosed as VSD, (4) 6cases(2.0%) were diagnosed as PDA+ASD,(5) 5cases(1.6%) were diagnosed as VSD+ASD,(6) 2 cases(each0.7%) for PDA+VSD,VSD+ASD+PDA, VSD+ASD+PDA+PH respectively.1 case(0.3%) was diagnosed as CAVSD+PDA+PH, and 6 cases(2.0%of other types.294 cases(96.39%) were left-to-right shunt lesions of heart structure anomaly,5 cases(1.64%) were right-to-left shunt lesions of heart structure anomaly,5 cases(1.97%) were non-shunt lesions,follow-ups and ECHO reexamination were needed.2.Surveillance and follow-ups were done by pediatrics cardiopathy specialists of the Out-patients Department in KiangWu Hospital.In reexaminations of ECHO on infants of 1-month-old for the studies on PDA,ASD and VSD closure situations:(1) ECHO shows 171 cases of PDA,156 cases of natural closure,PDA nature close rate were 91.2%,(2) of 81 cases ASD,70 cases were nature closed ASD naturally closed rate were 86.4%,(3) among 29 cases of VSD,6 cases were naturally closed,the VSD natural close rate was 20.7%.3.ECHO tests on infants of 1-month-old showed 57 cases of abnormal heart structure or congenital heart diseases,they were:23 cases(40.4%)of VSD,15 cases(26.3%) of PDA,11 cases(19.3%) of ASD,2 cases(3.5%) of VSD+ASD+PH,one case each of(each 1.8%) CAVSD+PDA+PH,VSD+PH,PS,AI,mitral cleft,double superior vena caval,regular follow-ups and ECHO reexaminations were needed.4.The continuous surveillance and follow-ups taken on 18 cases of CHD in this research shows an incidence rate of 8.47%.The 18 cases of CHD were:VSD 5 cases(27.8%),ASD 3cases(16.7%).PDA 2cases(11.1%),and one case each of VSD+ASD+PH,ASD+PH,CAVSD+PDA+PH,VSD+PH,PS,AI,MI,double superior vena cava(5.6%).11 cases (61.11%) were left-to-right shunt lesions of heart structure anomaly,3 cases(16.67%) were right-to-left shunt lesions of heart structure anomaly,4cases(22.22%) were non-shunt lesions.10 cases(55.6%) were male infants,while 8(44.4%) were female.5.The main pathogenic factors were chromosome aberration,uterus infection such as Rubella Virus(RUB) and Cytomegalovirus(CMV) infection,expectant mothers with age＞35ys,and environmental factors,etc.6.There were 18 cases diagnosed to be CHD in this study,7 cases required intervention treatment in follow-up period,1 case(5.6%) were given oral medicine treatment.2 cases (11.1%) were given surgical treatment,4 cases(22.22%) surgical Treatment+oral medicine treatment.In total there the altogether 6 cases by surgery.2 of them(11.11%) had radical operations,such as VSD repairing and PDA banding.4 cases(22.22%) were taken staging operation.For one case diagnosed as VSD+PH,the first-staging operation was PA banding. VSD repairing +MPA release operation were done later.For 2 cases of VSD+ASD+PH,the first stage operation of PA banding was done,selective VSD+ASD repairing+MPA Banded release operation will be done according to the continuous surveillance on VSD and ASD situations.One other case,CAVSD+PDA+PH,complex CHD,has undertaken the first staging operation of PA banding and PDA banding,selective CAVSD repairing radical operation+MPA Banded release operation.The above surgeries were 100%successfully done with no death case.ECHO tests taken 24 hour after surgery,one months,three months and half year follow-up visits later showed satisfactory result for all cases.The operation fields did not shown abnormal residual bypass,heart functions of each case were normal, and the curative effect was satisfactory.Conclusion It was discovered that the abnormal heart structure rate of Macao infant was14.36%in 2 to 5 days after birth(305/2124).the first five heart structure anomaly were:(1) PDA(171 cases,56.1%);(2) ASD/PFO(81cases,26.6%);(3) VSD(29cases,9.5%);(4) PDA+ASD(6cases,2.0%);(5) VSD+ASD(5cases,1.6%).96.39%(294/305) among the cases were left-to-right shunt lesions of heart structure anomaly,1.64%(5/305) were right-to-left shunt lesions of heart structure anomaly,1.97%(6/305) were non-shunt lesions,and needed continuous follow-up visits and ECHO reexamination.The results in one months born reexamination of ECHO for PDA,ASD natural closure was obvious:(1) ECHO showed in 171 cases of PDA,156 cases were naturally closed.PDA natural close rate was 91.2%,(2) Among 81 cases of ASD,70 cases were natural closed.ASD natural close rate was 86.4%,(3) of 29 cases of VSD,6 cases were naturally closed.VSD naturally close rate was 20.7%.This group of data showed that taking ECHO checking for the CHD in one month after birth would give a better effect for key surveillance and caring for babies with abnormal heart structure in their infant time.This group of data for the studies of CHD incidence was pretty much the same with the data from similar studies done in Mainland China and overseas.Of the 2124 infants,18 cases were diagnosed as CHD,with an incidence of 8.47%.Among these 18 cases of CHD:VSD case occupied the most of them(5 cases,27.8%),the second one was ASD(3cases,16.7%),PDA the third(2cases, 11.1%).11 cases(61.11%) were left-to-right shunt lesions of heart structure anomaly, 3caes(16.67%) were right-to-left shunt lesions of heart structure anomaly.4 cases(22.22%) were non-shunt lesions.In the 18 cases of CHD,7 cases needed intervention treatment in the follow-up period.1 case(5.6%) was given oral medicine treatment,2 cases(11.1%) surgical treatment,and 4 cases(22.22%) surgical treatment + oral medicine treatment.All surgery was 100%successful with no death case.ECHO showed satisfactory result on all case in 24 hours after operation and follow-up visits after 1 month,3 months and half year.The operation field did not shown abnormal residual bypass.This study shows that desirable short term curative effect can be obtained from surgery treatment under careful control of adaptation.Satisfactory result was obtained from the follow-up visits,surveillance and some effective curing proposals on some infants with abnormal heart structure.Moreover,this study has demonstrated high-risk factors for pathogenesis,which are chromosome aberration,uterus infection such as Rubella Virus(RUB) and Cytomegalovirus(CMV) infection,expectant mothers of age＞35ys,and environmental factors,etc.
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