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Differences by Altitude in the Frequency of Congenital Heart Defects in Colombia

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Abstract

More evidence is needed that links the diagnosis of different congenital heart diseases (CHD) identified after birth, with intermediate altitudes above sea level in geographically and ethnically diverse populations. Our aim was to estimate relative frequencies of CHD diagnosis by altitude and gender in the pediatric population of 12 cities in Colombia. This was a cross-sectional study based on the information collected between 2008 and 2013 in Colombia, during annual congenital heart disease (CHD) case detection campaigns in the post-natal period. All children underwent physical examination, pulse-oximetry, and echocardiography. The odds ratio (OR) was used as the summary statistic to assess associations with altitude in the relative frequency of CHD diagnosis. Data from 5900 children who attended the campaigns were evaluated (54.3 % male), out of which 3309 (56.1 %) were diagnosed with CHD. There were statistically significant differences in the relative distribution of the different CHD by city altitude and gender (p < 0.0001). When compared with sea level, altitudes between 1285 and 3000 m above sea level were associated with increased Patent Ductus Arteriosus (PDA) (ORmh 1.68, 95 % CI 1.34–2.09; p < 0.0001) and left ventricular outflow tract obstruction (LVOTO) diagnoses (ORmh 2.06, 95 % CI 1.63–2.61; p < 0.0001), while the opposite was true for right ventricular outflow tract (RVOTO) diagnosis (OR 0.60; 95 % CI 0.49–0.74, p < 0.0001). These associations were not modified by gender differences. In a geographically and ethnically diverse population, altitudes between 1285 and 3000 m above sea level carried an independent and clinically important excess diagnostic risk of PDA and of LVOTO, when compared to all other CHD.

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Abbreviations

CHD:

Congenital heart disease

VSD:

Ventricular septal defect

RVOTO:

Right ventricular outflow track obstruction

ASD:

Auricular septal defect

PDA:

Patent Ductus Arteriosus

LVOTO:

Left ventricular outflow track obstruction

m.a.s.l:

Meters above sea level

kg:

Kilograms

cms:

Centimeters

OR:

Odds ratio

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Acknowledgments

We would like thank all collaborators in the different Colombian cities that donate their precious time for the CHD case detection campaigns and who have maintained the conviction of their beneficial impact on the affected families. We would like to thank all the personnel of the Departments of Social Responsibility and Pediatric Cardiology at FCI-IC, as well as all pediatric volunteers who travel every year to the different cities to cooperate with the campaigns.

Funding Sources

This study was possible thanks to the activities of Fundación Cardioinfantil´s social campaign program “Regale una vida”, and to funding to support research centers of excellence by the Administrative Department of Science, Technology and Innovation (COLCIENCIAS) of the Colombian Government, Grant 725-2015.

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Authors and Affiliations

  1. Institute for Congenital Heart Disease, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia

    Alberto García, Miguel Ronderos & Néstor Sandoval

  2. Research Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia

    Karen Moreno & Rodolfo J. Dennis

  3. Department of Nursing, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia

    Mónica Caicedo

Authors
  1. Alberto García
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  2. Karen Moreno
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  3. Miguel Ronderos
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  4. Néstor Sandoval
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  6. Rodolfo J. Dennis
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Corresponding author

Correspondence to Rodolfo J. Dennis.

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None of the authors disclose any conflicts of interest.

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García, A., Moreno, K., Ronderos, M. et al. Differences by Altitude in the Frequency of Congenital Heart Defects in Colombia. Pediatr Cardiol 37, 1507–1515 (2016). https://doi.org/10.1007/s00246-016-1464-x

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  • DOI: https://doi.org/10.1007/s00246-016-1464-x

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