Cardiovascular anomalies in patients with oro-facial clefts: a prospective case controlled study

James, O. ; Sokunbi, O.J. ; Agbogidi, F.O. ; Adekunle, A.A. ; Ogunlewe, A.O. ; Ekure, E.N. ; Adeyemo, W.L. ; Ladeinde, A.L. ; Ogunlewe, M.O. (2019-08-21)

14th Annual Conference and Fair, University of Lagos


BACKGROUND Orofacial clefts are among the most common birth defects, occurring in about 1.7 per 1000 newborns (Correia-Costa et al 2010). The reported incidence varies with different studies, however a nationwide hospital-based study in Nigeria reported a prevalence of 0.5 per 1000 live-birth (Butali et al 2014). This heterogeneous group of disorders can occur as an isolated condition or in association with other congenital anomalies or syndromes (Rittler et al 2008; Altunhan et al 2012; James et al 2014;). The frequency and type of associated malformations observed varies considerably across studies (Hagberg et al 1998; Stoll et al 2000; Wehby and Murray 2010; James et al 2014). The study by Hagberg et al (1998) indicated that 21–37% of orofacial cleft patients have other anomalies of which 24–51% involved the cardiovascular system. Cardiovascular anomaly is always a concern in a child born with a cleft palate (Fillies et al 2007; Sekhon et al 2011; Harry et al 2013). This anomaly may have an impact on the timing of cleft repair and the need for sub-acute bacterial endocarditis prophylaxis (Fillies et al 2007). The presence of these anomalies may mandate cardiac surgery before cleft repair (Fillies et al 2007). Cardiac anomaly may also impact on the incidence of anaesthetic risk/complication during surgery under general anaesthesia (Shprintzen et al 1985; Fillies et al 2007). The incidence and pattern of cardiac anomalies associated with orofacial cleft in our environment is also still unknown. It is therefore important to identify the types of cardiac anomalies and their pattern of presentation in Nigerian patients. The result of this study will provide baseline information on the incidence and pattern of presentation of cardiovascular anomalies in Nigerian subjects with congenital oro-facial cleft and possibly facilitate the development of a surgical management protocol for cleft patients with the cardiac abnormalities. AIM: To study the prevalence and pattern of cardiovascular anomalies in a population of patients with orofacial clefts and compare with those of age and sex matched control subjects. METHODOLOGY This study was conducted at the Oral and Maxillofacial Surgery Cleft Clinic, Pediatric and Community Health Outpatient Clinics of the Lagos University Teaching Hospital. Subjects were all consecutive cleft lip and palate subjects aged 2 months and above. Age and sex matched control subjects who are without cleft lip and palate were also recruited. All eligible subjects (cases and controls) who attend the cleft lip and palate clinic of the hospital had a full clinical examination done at the first visit and during subsequent review appointments. Socio demographic characteristics of the patients and other variables as well as other relevant clinical information about the cleft lip and palate disorder was recorded on a proforma As part of the evaluation, cardiovascular assessment was carried out on all the subjects (case and control) by a Pediatric Cardiologist. All subjects thereafter had electrocardiography (ECG) and Echocardiography tests done. The results were then interpreted by the pediatric cardiologist. The systemic assessment, ECG and echocardiography report was documented in another profoma. RESULT: A total of 120 subjects who satisfied the inclusion criteria participated in the study with 60 subjects in each group. There were 63 (52.5%) males and 57 (47.5%) females with a male-to-female ratio of 1.1:1. Of the 60 subjects in the oro-facial cleft group, 14 (23.3%) had bilateral cleft lip and palate, 12(20%) had unilateral cleft lip and palate, 13(21.7%) had isolated cleft of the palate. Four (6.67%) of the control subjects was diagnosed with congenital heart defects while 17(28.3%) of the oro-facial cleft group had congenital heart defect (p=0.001) Conclusion: This study shows a statistically significant higher incidence of cardiovascular anomalies in subjects with orofacial clefts than age and sex matched control subjects.