Cholelithiasis in children with CHD: is it a problem?
BACKGROUND
An association of heart disease and its treatment with biliary calculi is popularly accepted. We sought determine the prevalence and risk factors of paediatric gallstone disease in the presence of CHD and analyse the treatment options. We evaluated the role of open-heart surgery in the development of gallstones in patients with CHD. Patients and methods In a 10-year, retrospective, chart review (2005-2014), patients with CHD and cholelithiasis were identified and reviewed.


RESULTS
In all, 19 of 4729 children with CHD had cholelithiasis (0.4%); eight patients underwent cardiac surgery before diagnosis of cholelithiasis (group 1), whereas 11 of them had not (group 2). The prevalence was 0.3% in group 1 and 0.5% in group 2. In nine asymptomatic patients, gallstones were found incidentally. Children with cholecystolithiasis (n=17) received ursodeoxycholic acid. A resolution of gallstones was found in four cases; two patients underwent biliary surgery, and the others (15/17) were successfully managed non-operatively.


CONCLUSION
Despite an accumulation of risk factors, prevalence of gallstones is not as high as expected in children with CHD. Open-heart surgery with a heart-lung machine plays a minor role as an aetiological factor. In about half of the cases, cholelithiasis is an incidental finding and patients stay asymptomatic. Prophylactic administration of ursodeoxycholic acid is not indicated in children undergoing open-heart surgery for CHDs. Biliary surgery is reserved for patients with recurrent symptoms or cholestasis. In children with CHD, cholelithiasis is a minor and manageable co-morbid condition.
['Kargl|Simon|S|', 'Gitter|Roland|R|', 'Pumberger|Wolfgang|W|']
D001317:Austria D006348:Cardiac Surgical Procedures D002648:Child D002675:Child, Preschool D015897:Comorbidity D019468:Disease Management D005260:Female D042882:Gallstones D006330:Heart Defects, Congenital D006801:Humans D007223:Infant D007231:Infant, Newborn D008297:Male D015995:Prevalence D012189:Retrospective Studies D012307:Risk Factors D014463:Ultrasonography
cholelithiasis children CHD