Epidemio-clinical and echographic aspects of the atrio -ventricular canal in Madagascar

Introduction: Atrioventricular canal defect (AVCD) is a congenital heart malformation characterized by a variable degree of atrial and ventricular septal defect [1] . Anatomically, there are partial, complete and intermediate forms [2] . This first Malagasy study was designed to describe its epidemio -clinical aspects in children with AVCD and to determine the factors influencing the prognosis but also to serve as a database of AVCD in Madagascar.

Method: This was a retrospective, descriptive and analytical study over a period of 20 years on 98 patients with AVCD seen at the Soavinandriana Hospital Center (CENHOSOA) Antananarivo.

Results: We found that AVCD represented 4.70% of congenital heart diseases observed with a mean age of discovery of 29.24 months and a male predominance (sex ratio of 1.61). The complete form represented 84.54% of cases. Trisomy-21 was found in 46.39% of patients. Atrial septal defect (ASD) (12.37%) and ventricular septal defect (VSD) (8.25%) were the main associated cardiac malformations followed by transposition of the great vessels (8.25%). Signs of heart failure were present in 27.83% of cases and 34.02% had pulmonary hypertension (PH) of which 11.34% had Eisenmenger syndrome. In this study, age of discovery more than 12 months was associated with the onset of PH and Eisenmenger syndrome (p = 0.03 and 0.01). Non-trisomy patients tend to present with heart failure and PH (p = 0.02 and 0.01).

Conclusion: Cardiovascular exploration is required in all infants with Down syndrome and those who present signs 
of CAV. Delayed diagnosis remains the main factor in poor prognosis of CAV in Madagascar.