Cardiac anomalies in children with congenital duodenal obstruction: a systematic review with meta-analysis

Background: Cardiac anomalies occur frequently in patients with congenital duodenal obstruction (DO). However, the exact occurrence and the type of associated anomalies remain unknown. Therefore, the aim of this systematic review is to aggregate the available literatures on cardiac anomalies in patients with DO. Methods: In July 2022, a search was performed in PubMed and Embase.com. Studies describing cardiac anomalies in patients with congenital DO were considered eligible. Primary outcome was the pooled percentage of cardiac anomalies in patients with DO. Secondary outcomes were the pooled percentages of the types of cardiac anomalies, type of DO, and trisomy 21. A meta-analysis was performed to pool the reported data. Results: In total, 99 publications met our eligibility data, representing 6725 patients. The pooled percentage of cardiac anomalies was 29% (95% CI 0.26–0.32). The most common cardiac anomalies were persistent foramen ovale 35% (95% CI 0.20–0.54), ventricular septal defect 33% (95% CI 0.24–0.43), and atrial septal defect 33% (95% CI 0.26–0.41). The most prevalent type of obstruction was type 3 (complete atresias), with a pooled percentage of 54% (95% CI 0.48–0.60). The pooled percentage of Trisomy 21 in patients with DO was 28% (95% CI 0.26–0.31). Conclusion: This review shows cardiac anomalies are found in one-third of the patients with DO regardless of the presence of trisomy 21. Therefore, we recommend that patients with DO should receive preoperative cardiac screening. Level of evidence: II.