Mohammed Nasir, Mekdes Wendmagegn, Getasew Ademu
Hawassa University.
Ethiopia
BioMedical Central Cardiovascular Disorders
BMC Cardiovasc Disord 2026;
DOI: 10.1186/s12872-026-06009-y
Abstract
Background: Given the limited data from developing countries, this study aimed to examine the patterns of congenital heart disease, associated complications, management, survival and mortality rates, and independent predictors of mortality in children.
Methodology: This retrospective multicenter follow-up study was conducted at five hospitals in Hawassa, Ethiopia, from April 1 to July 1, 2025, including children seen between January 1, 2015, and January 1, 2025. Patterns of congenital heart disease, complications, and management were summarized as frequencies and percentages. Mortality incidence was calculated per 1,000 person-years. Kaplan-Meier analysis estimated survival, and Cox proportional hazards regression identified independent mortality predictors.
Results: A total of 1,251 children met the inclusion criteria. Acyanotic congenital heart diseases predominated (1,110; 88.7%), with Ventricular septal defect (384; 30.7%), patent ductus arteriosus (207; 16.5%), and secundum atrial septal defect (158; 12.6%) being the most common. Over a median follow-up of 5 years (IQR: 4-7), 1,043 children (83.4%) developed at least one complication, most frequently New York Heart Association (NYHA)/Modified Ross class III/IV heart failure (HF) (204; 16.3%) and isolated pulmonary hypertension (PH) (168; 13.4%). Most children were managed medically (1,210; 96.7%), 23 (1.8%) received follow-up care only, and 18 (1.4%) underwent intervention (17 surgeries and 1 catheter-based procedure). Among the 1,013 children (81.0%) with indications for surgical or catheter-based intervention, only 18 (1.4%) actually received the procedure, indicating that the vast majority of eligible children did not undergo intervention. Overall survival was 96.6%, 95.0%, 90.2%, and 84.6% at 1, 3, 5, and 10 years, with a mortality incidence of 18.9 per 1,000 person-years (95% CI: 15.9-22.4). Mortality risk was higher in children with syndromic association (HR = 2.9; 95% CI: 2.0-4.3; p = 0.02), severe acute malnutrition (SAM) (HR = 3.3; 95% CI: 2.4-4.9; p < 0.001), severe biventricular congenital heart disease (HR = 1.8; 95% CI: 1.2-2.7; p = 0.02), severe univentricular congenital heart disease (HR = 11.5; 95% CI: 8.2-19.4; p < 0.001), NYHA/modified Ross class III/IV HF (HR = 1.9; 95% CI: 1.1-2.7; p = 0.03), PH (HR = 1.4; 95% CI: 1.2-2.3; p = 0.02), and an indication for surgical or catheter-based intervention (HR = 1.8; 95% CI: 1.1-4.1; p = 0.04).
Conclusion: Acyanotic congenital heart diseases, mainly ventricular septal defect, patent ductus arteriosus, and secundum atrial septal defect, were most common. Over three-quarters of children developed complications, including at admission. Few received the needed surgical or catheter-based interventions. Survival was low, exceeding developed-country mortality. Syndromic features, advanced HF, PH, congenital heart disease complexity, and intervention need predicted mortality, highlighting the significance of early diagnosis and care.
Category
Class I. Pulmonary Hypertension Associated with Congenital Cardiovascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes