1. Presented by Malouny SISAVANH, MD

2. Summary of Cases * Repeated or follow-up exams included. † “Others” indicates any acquired cardiac problems from infectious, degenerative, and atherosclerotic causes. * † From 2013-07-12 to 2013-11-19 Total 140 cases (including repeated or follow-up exams) - CHD: 33 cases - Others: 29 cases Average: 1.5 case/day

3. Summary of Cases * Repeated or follow-up exams excluded. † “Others” indicates any acquired cardiac problems from infectious, degenerative, and atherosclerotic causes. * † From 2013-07-12 to 2013-11-19 Total 115 patients (excluding repeated or follow-up exams) - CHD: 25 patients - Others: 12 patients

4. Indication of Test IndicationNumber (%) Routine check-up (including preoperative evaluation) 19 (16.5%) Cardiac murmur11 (9.6%) CXR abnormality (Cardiomegaly / Pulmonary edema / Pleural effusion / Etc) 4 (3.5%) Dyspnea / Hypoxemia / Heart Failure13 (11.3%) Suspicious of Congenital Heart Disease (Specific indications were not provided) 21 (18.3%) Suspicious of Kawasaki Disease5 (4.3%) Suspicious of Infective Endocarditis3 (2.6%) Suspicious of Diphtheric Myocarditis1 (0.9%) Chest pain7 (6.1%) Palpitation / Arrhythmia14 (12.2%) Fatigue / Dizziness13 (11.3%) Peripheral edema2 (1.7%) Unspecified2 (1.7%) Total115 patients (100.0%)

5. Details of Patients CHDNumber PDA6 ASD4 VSD3 ASD + PDA3 ASD + VSD3 PDA + Bicuspid AoV1 ASD + VSD + PDA1 Severe TR + ASD + VSD1 AVSD1 TOF1 Total25 patients OthersNumber Cardiac tamponade1 Uremic cardiomyopathy2 Coronary aneurysm (due to history of KD) 1 Kawasaki disease1 Ischemic cardiomyopathy1 Diastolic Heart Failure1 Rheumatic MSR with ASR1 Pericardial effusion2 Infective endocarditis1 Diphtheric myocarditis1 Total12 patients

6. Important Features 1.Undiagnosed and Unrepaired Congenital Heart Diseases are common in Adolescents or Adults 2.Cyanotic or Complex Congenital Heart Diseases are Rare Insufficient neonatal screening Lack of knowledge (patients / physicians) Limited hospital accessibility

7. Problems 1.Referral for Surgery is Limited – Cardiac surgery is available only in Mahosot Hospital, performed by foreign volunteer doctors (from western countries) – No cardiac surgery team in the Children’s Hospital – Post-operative outcome is unknown 2.Lack of Sedation System – EchoCG in the Children’s Hospital: Time- and Effort-consuming work 3.Economic and Social Situation – Patients/Parents cannot afford medical/surgical costs 4.Lack of Pathologic / Microbiologic / Serologic Laboratories – Routine laboratory tests are impossible or limited

8. Acknowledgement In-Chang Hwang, M.D (KOICA volunteer doctor in children’s hospital)