Pediatr Cardiol 16:172-175, 1995 Pediatric Cardiology Springer-Verlag New York Inc. 1995 Risk of Pulmonary Tuberc,aosis in Children with Congenital Heart Disease P.-L. van der Merwe, N. Kalis, H.S. Schaaf, E.H. Nel, R.P. Gie Department of Pediatrics and Child Health, University of Stellenbosch, Tygerberg Hospital, PO Box 19063, Tygerberg 7505, Republic of South Africa Abstract. Children with low-flow congenital heart lesions are reported to have an increased incidence of pulmonary tuberculosis. The aim of this study was to investigate if children with congenital heart disease have an increased incidence of pulmonary tuberculosis and to determine if patients with cer- tain heart conditions are more susceptible to pul- monary tuberculosis than others. This retrospective study over a 6-year period showed that pulmonary tuberculosis was 2.5-fold more common in children with congenital heart disease than in normal chil- dren from the same community. Children with con- genital pulmonary stenosis had a prevalence equal to those with acyanotic (ventricular and atrial septal defects) and cyanotic (transposition of the great ar- teries) high-flow heart lesions, whereas there were no cases of tuberculosis in children with low-flow cyanotic heart lesions such as tetralogy of Fallot. Cardiac surgery had to be postponed as a result of pulmonary tuberculosis in 7.2% of all patients in whom it was required. Over the 6-year period of the study, cardiac surgery had to be delayed in 60% of cases with pulmonary tuberculosis and congenital heart lesions so antituberculosis therapy could be completed. Physicians treating children with con- genital heart lesions should maintain a high index of suspicion for the development of pulmonary tuber- culosis, especially in those with acyanotic and cy- anotic high-flow lesions and pulmonary stenosis, Key words: Congenital heart disease--Pulmonary tuberculosis With the resurgence of tuberculosis in the industri- alized and developing world [7], children with risk Correspondence to: P.-L. van der Merwe factors for pulmonary disease are at increased risk of developing pulmonary tuberculosis. Although children with congenital heart disease have an in- creased risk for repeated respiratory tract infec- tions, especially pneumonia [1], it is uncertain if they are at increased risk of developing pulmonary tuberculosis and its complications during child- hood. Sir Thomas Lewis stated that children with congenital heart lesions have an increased inci- dence of pulmonary tuberculosis [10], but we were unable to verify his statement, as a wide search of the literature revealed only a few case reports to support it [5]. If there is an increased incidence of pulmonary tuberculosis in children with congenital heart disease, the clinical picture, radiologic image, and rate of complications are unknown. Tuberculosis is one of the largest health prob- lems in the Western Cape, the region of South Af- rica where our institution is situated, with an inci- dence of >600 new cases per 100,000 inhabitants per year [13]. The incidence of childhood tubercu- losis is >450 new cases per 100,000 children per year, which is approximately three times higher than the national reported incidence [9]. The purpose of this study was to determine (1) if children with congenital heart disease have an increased risk of developing pulmonary tuberculo- sis during childhood, and (2) if children with con- genital pulmonary stenosis have a higher incidence of pulmonary tuberculosis than children with other congenital heart diseases. Patients and Methods This retrospective study was performed by examining the records of all the children admitted to the cardiology wards of the Department of Paediatrics and Child Health at our institution, a tertiary teaching hospital, over the past 6 years. All the files of the 839 children with congenital heart disease were carefully