engleski

The importance of folic acid in the onset of congenital heart disease

Congenital heart disease (CHD) represents major epidemiological problem in current medicine. Annual incidence of 1% newborns with CHD is constant, and among them 30% have conotruncal anomalies. Conotruncal anomalies are somewhat heterogenic group, with disturbed development of conal tissue and arterial trunk. Conotruncal anomalies can be present in an isolated form or as a part of recognizable clinical syndromes. In different epidemiological studies their incidence range from 12 to 30% of all CHD's, but the mortality rate is the highest in this group. Beside high mortality rate, these children enter adult age in higher percentage as chronically ill patients then other groups of CHD's, which has a negative impact on the economical aspect of the problem. Etiology of conotruncal anomalies is associated with several chromosomal anomalies (22q11 deletion, 10p deletion), with inadequate dietary intake of folic acid and some teratogenic agents (retinoic acid, alcohol). Inadequate dietary intake of folic acid and teratogenic agents are responsible for 30% of conotruncal anomalies. Folic acid is essential, and in humans origins from dietary intake and endogenous bacterial production in intestines. Inadequate dietary intake of folic acid in humans results in development of megaloblastic anaemia, gastrointestinal disturbances as well as congenital heart and central nervous system anomalies. Major pathological event is disturbed migration of neural crest cells from which conal trunks as well as central nervous system are developed. These disturbances result in pathological migration of embryonic heart cells with development of severe CHD’ s and with neural tube formation anomalies. Preventive dietary intake of folic acid in periconceptional period (three months before and after conception) can significantly reduce incidence of these life-threatening anomalies. Approximately 60 newborns with conotruncal anomalies are born in Croatia annually and among them 30% could be prevented by periconceptional folic acid intake. The fact that some CHD’ s can be prevented with relatively simple and non-expensive treatment is encouraging in long-term prognosis of these patients.

folic acid, congenital heart disease, children, prevention

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