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McLean KC, Meyer MC, Peters SR, Wrenn LD, Yeager SB, Flyer JN. Obstetric imaging practice characteristics associated with prenatal detection of critical congenital heart disease in a rural US region over 20 years. Prenat Diagn 2024; 44:698-705. [PMID: 38459708 DOI: 10.1002/pd.6551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE To identify clinical practice characteristics associated with the frequency of prenatal critical congenital heart disease (CCHD) detection (i.e., the number of liveborn infants with postnatally confirmed CCHD identified on prenatal sonography) over 20 years in a rural setting comprised of 11 primarily low-volume obstetric hospitals and the single tertiary academic hospital to which they refer. METHODS This was a retrospective cohort study of all patients in the referral region with an initial prenatal and/or postnatal diagnosis of CCHD from 01/01/2002 to 12/31/2021. The frequency of prenatal CCHD detection at the time of an obstetric ultrasound was reported, as was the change in detection over time. Critical congenital heart disease detection was assessed as a function of cardiac lesion type, practice setting, and practice characteristics. RESULTS There were 271 cases with a confirmed postnatal CCHD diagnosis, of which 49% were identified prenatally. The majority of community practices each averaged <10 CCHD cases in total over the study period. Prenatal detection at the tertiary academic hospital's obstetric ultrasound unit was 64%, compared to 22% at the combined referring community practices (p < 0.001), though CCHD detection improved over time in both settings. Professional accreditation by the American Institute of Ultrasound in Medicine, image interpretation by radiology or Maternal Fetal Medicine, and use of video clips of ventricular outflow tracts were associated with improved prenatal CCHD detection. CONCLUSIONS Our data demonstrate the infrequency of CCHD cases at small-volume, rural hospitals and the substantial variation in prenatal CCHD detection across practice settings. Our methods allowed for the identification of practice characteristics associated with prenatal CCHD detection.
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Affiliation(s)
- Kelley C McLean
- Department of Obstetrics, Gynecology and Reproductive Sciences, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Marjorie C Meyer
- Department of Obstetrics, Gynecology and Reproductive Sciences, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Sarah R Peters
- Department of Obstetrics, Gynecology and Reproductive Sciences, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Lia D Wrenn
- Department of Obstetrics, Gynecology and Reproductive Sciences, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Scott B Yeager
- Department of Pediatrics, Division of Pediatric Cardiology, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Jonathan N Flyer
- Department of Pediatrics, Division of Pediatric Cardiology, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
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2
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Savoia F, Scala C, Coppola M, Riemma G, Vitale SG, Mikuš M, Schiattarella A, La Verde M, Colacurci N, De Franciscis P, Morlando M. The diagnostic performance of the ductus venosus for the detection of cardiac defects in the first trimester: a systematic review and diagnostic test accuracy meta-analysis. Arch Gynecol Obstet 2023; 308:435-451. [PMID: 36315269 PMCID: PMC10293352 DOI: 10.1007/s00404-022-06812-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 10/03/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Abnormal flow in the ductus venosus (DV) has been reported to be associated with adverse perinatal outcome, chromosomal abnormalities, and congenital heart defects (CHD). Aneuploid fetuses have increased risk of CHD, but there are discrepancies on the performance of this markers in euploid fetuses. The aim of this meta-analysis was to establish the predictive accuracy of DV for CHD. METHODS MEDLINE, EMBASE, and CINAHL were searched from inception to February 2022. No language or geographical restrictions were applied. Inclusion criteria regarded observational and randomized studies concerning first-trimester DV flow as CHD marker. Random effect meta-analyses to calculate risk ratio (RR) with 95% confidence interval (CI), hierarchical summary receiver-operating characteristics (HSROC), and bivariate models to evaluate diagnostic accuracy were used. Primary outcome was the diagnostic performance of DV in detecting prenatal CHD by means of area under the curve (AUROC). Subgroup analysis for euploid, high-risk, and normal NT fetuses was performed. Quality assessment of included papers was performed using QUADAS-2. RESULTS Twenty two studies, with a total of 204.829 fetuses undergoing first trimester scan with DV Doppler evaluation, fulfilled the inclusion criteria for this systematic review. Overall, abnormal DV flow at the time of first trimester screening was associated to an increased risk of CHD (RR 6.9, 95% CI 3.7-12.6; I2 = 95.2%) as well in unselected (RR: 6.4, 95% CI 2.5-16.4; I2 = 93.3%) and in euploid (RR: 6.45, 95% CI 3.3-12.6; I2 = 95.8%) fetuses. The overall diagnostic accuracy of abnormal DV in detecting CHD was good in euploid fetuses with an AUROC of 0.81 (95% CI 0.78-0.84), but it was poor in the high-risk group with an AUROC of 0.66 (95% CI 0.62-0.70) and in the unselected population with an AUROC of 0.44 (95% CI 0.40-0.49). CONCLUSIONS Abnormal DV in the first trimester increases the risk of CHD with a moderate sensitivity for euploid fetuses. In combination with other markers (NT, TV regurgitation) could be helpful to identify fetuses otherwise considered to be at low risk for CHD. In addition to the improvement of the fetal heart examination in the first trimester, this strategy can increase the detection of major CHD at earlier stage of pregnancy.
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Affiliation(s)
- Fabiana Savoia
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Carolina Scala
- Division of Obstetrics and Gynecology, Gaslini Institute, Genoa, Italy
| | - Marlene Coppola
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
| | - Mislav Mikuš
- Department of Obstetrics and Gynecology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Antonio Schiattarella
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco La Verde
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maddalena Morlando
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
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3
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Wong J, Kohari K, Bahtiyar MO, Copel J. Impact of prenatally diagnosed congenital heart defects on outcomes and management. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:646-654. [PMID: 35543387 DOI: 10.1002/jcu.23219] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 06/14/2023]
Abstract
Fetal echocardiogram aids in prenatal identification of neonates at high risk for congenital heart defects (CHD). Prenatal detection rates for CHD have increased with improved ultrasound technology, the use of the early fetal echocardiography, and standardization of the performance of the fetal echocardiogram. Accurate prenatal detection of CHD, particularly complex CHD, is an important contributor to improved survival rates for patients with CHD. Early detection allows for families to choose whether or not to continue with pregnancy, referral to pediatric cardiology specialists for patient education, and delivery planning. Better psychosocial supports are needed for families with CHD.
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Affiliation(s)
- Jennifer Wong
- Section of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Katherine Kohari
- Section of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mert Ozan Bahtiyar
- Section of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Joshua Copel
- Section of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
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4
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Zhang X, He S, Liu Y, Zhong J, Sun Y, Zheng M, Gui J, Wang R, Feng B, Mo J, Jian M, Liu C, Liang Y. The significance of an integrated management mode of prenatal diagnosis-postnatal treatment for critical congenital heart disease in newborns. Cardiovasc Diagn Ther 2021; 11:447-456. [PMID: 33968622 DOI: 10.21037/cdt-20-892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Congenital heart disease (CHD) is the most common congenital defect in human beings. The purpose of this article is to investigate impact of an integrated management mode of 'prenatal diagnosis-postnatal treatment' on birth, surgery, prognosis and complications associated with critical CHD (CCHD) in newborns. Methods A retrospective analysis of the medical records of newborns diagnosed with CCHD were divided into two groups: prenatal diagnosis and postnatal diagnosis. The demographics, clinical characteristics, surgical status, prognosis and complications of the two groups were compared and the differences identified. Results Among the 290 newborns with CCHD, 97 (33.4%) were prenatally diagnosed and 193 (66.6%) were postnatally diagnosed. Newborns in the prenatal diagnostic group were hospitalized immediately after birth, whereas the median age of admission was 6.00 (3.00-12.00) days in postnatal diagnostic group, P=0.000. In terms of postnatal symptoms and signs, the incidence of anhelation, cyanosis and cardiac murmur was higher in the postnatal diagnostic group. The rates of preoperative intubation, postoperative open chest exploration and treatment abandonment were higher in the postnatal diagnostic group. The postnatal diagnostic group was more prone to postoperative complications, such as pneumonia and hypoxic-ischemic brain damage. The preoperative mortality [0 (0.0%) vs. 12 (6.2%), P=0.028] in the prenatal diagnostic group was lower than that in the postnatal diagnostic group. And the one-year survival rate of the prenatal diagnostic group was higher (log-rank test P=0.034). Conclusions The integrated management mode of prenatal diagnosis-postnatal treatment can improve postnatal symptoms, reduces complications, reduces preoperative mortality and increases one-year survival rates in newborns with CCHD.
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Affiliation(s)
- Xiaohui Zhang
- Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shaoru He
- Department of NICU, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, China
| | - Yumei Liu
- Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jing Zhong
- Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yunxia Sun
- Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Manli Zheng
- Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Juan Gui
- Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ruixi Wang
- Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bowen Feng
- Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jianling Mo
- Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Minqiao Jian
- Department of NICU, Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Caisheng Liu
- Department of NICU, Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Yijing Liang
- Department of NICU, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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van Velzen CL, Ket JCF, van de Ven PM, Blom NA, Haak MC. Systematic review and meta-analysis of the performance of second-trimester screening for prenatal detection of congenital heart defects. Int J Gynaecol Obstet 2017; 140:137-145. [PMID: 29094357 DOI: 10.1002/ijgo.12373] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/11/2017] [Accepted: 10/31/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND The prenatal detection rate of congenital heart defects (CHDs) is increasing, but reported rates vary. OBJECTIVES To determine the performance of the second-trimester anomaly scan to detect CHD. SEARCH STRATEGY PubMed and Embase were searched for relevant studies in any language from inception to February 3, 2017. The search terms included "prenatal diagnosis" or "pregnancy," "cardiovascular diseases" or "cardiac defects," "congenital," and "specificity," or "sensitivity," or "cohort study." SELECTION CRITERIA Cohort studies assessing the detection rate of CHD during population-based prenatal screening from 1995 were eligible for inclusion. DATA COLLECTION AND ANALYSIS Data were collected from identified studies; authors were approached for additional data when necessary. A review and meta-analysis were performed. When possible, separate analyses were undertaken for isolated CHD cases. MAIN RESULTS Meta-analysis of seven studies showed the pooled detection rate of CHD in unselected populations as 45.1% (95% confidence interval 33.5%-57.0%). However, the rate of detection of univentricular defects and heterotaxy was above 85%. Similar rates were found among cases of isolated CHD. CONCLUSIONS Prenatal detection showed a strong correlation with CHD severity. The detection of conotruncal anomalies needs to improve. A thoroughly organized screening program will be essential to achieve a higher detection rate.
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Affiliation(s)
- Christine L van Velzen
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, Netherlands
| | | | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Nico A Blom
- Department of Pediatric Cardiology, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands.,Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Monique C Haak
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, Netherlands
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6
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Fetale Herzdiagnostik. Monatsschr Kinderheilkd 2017. [DOI: 10.1007/s00112-017-0365-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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7
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Morphological features of complex congenital cardiovascular anomalies in fetuses: as evaluated by cast models. ACTA ACUST UNITED AC 2017; 37:596-604. [DOI: 10.1007/s11596-017-1778-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 07/10/2017] [Indexed: 12/19/2022]
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8
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Eschenbach LK, Kasnar-Samprec J, Ackermann K, Schreiber C, Lange R, Cleuziou J. Preoperative Venovenous ECMO in an Infant With Late Diagnosis of Hypoplastic Left Heart Syndrome. World J Pediatr Congenit Heart Surg 2017; 11:NP41-NP43. [PMID: 28677480 DOI: 10.1177/2150135117697228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Late diagnosis and late referral for the Norwood stage 1 procedure in patients with hypoplastic left heart syndrome is rare and associated with a higher mortality. We present a case of a cyanotic almost five-week-old infant with hypoplastic left heart syndrome, highly restrictive foramen ovale, and patent ductus arteriosus, who was bridged with venovenous extracorporeal membrane oxygenation to the Norwood stage 1 procedure.
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Affiliation(s)
- Lena K Eschenbach
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Jelena Kasnar-Samprec
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Kilian Ackermann
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Christian Schreiber
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Rudiger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Julie Cleuziou
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
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9
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Collins JW, Soskolne G, Rankin KM, Ibrahim A, Matoba N. African-American:White Disparity in Infant Mortality due to Congenital Heart Disease. J Pediatr 2017; 181:131-136. [PMID: 27836287 DOI: 10.1016/j.jpeds.2016.10.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 08/29/2016] [Accepted: 10/06/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the importance of infant factors, maternal prenatal care use, and demographic characteristics in explaining the racial disparity in infant (age <365 days) mortality due to congenital heart defects (CHD). STUDY DESIGN In this cross-sectional population-based study, stratified and multivariable logistic regression analyses were performed on the 2003-2004 National Center for Health Statistics linked live birth-infant death cohort files of term infants with non-Hispanic white (n = 3 684 569) and African-American (n = 782 452) US-born mothers. Infant mortality rate, including its neonatal (<28 day) and postneonatal (28-364 day) components, due to CHD was the outcome measured. RESULTS The infant mortality rate due to CHD for African-American infants (296 deaths; 3.78 per 10 000 live births) exceeded that of white infants (1025 deaths; 2.78 per 10 000 live births) (relative risk [RR], 1.36; 95% CI, 1.20-1.55). The racial disparity was wider in the postneonatal period (2.08 per 10 000 vs 1.42 per 10 000; RR, 1.53; 95% CI, 1.29-1.83) compared with the neonatal period (1.70 per 10 000 vs 1.44 per 10 000; RR, 1.20; 95% CI, 0.99-1.45). Compared with white mothers, African-American mothers had a higher percentage of high-risk characteristics. In multivariable logistic regression models, the adjusted OR of postneonatal and neonatal mortality due to CHD for African-American mothers compared with white mothers was 1.20 (95% CI, 0.98-1.48) and 0.95 (95% CI, 0.77-1.19), respectively. CONCLUSION The racial disparity in infant mortality rate due to CHD among term infants with US-born mothers is driven predominately by the postneonatal survival disadvantage of African-American infants. Commonly cited individual-level risk factors partly explain this phenomenon. The study is limited by the lack of information on neighborhood factors.
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Affiliation(s)
- James W Collins
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
| | - Gayle Soskolne
- Division of Critical Care Medicine, University of California San Francisco, Benioff Children's Hospital Oakland, Oakland, CA
| | - Kristin M Rankin
- Department of Epidemiology, University of Illinois School of Public Health, Chicago, IL
| | - Alexandra Ibrahim
- Department of Epidemiology, University of Illinois School of Public Health, Chicago, IL
| | - Nana Matoba
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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10
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A systematic review of prenatal screening for congenital heart disease by fetal electrocardiography. Int J Gynaecol Obstet 2016; 135:129-134. [PMID: 27634052 DOI: 10.1016/j.ijgo.2016.05.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/21/2016] [Accepted: 07/27/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Congenital heart disease (CHD) is the most common severe congenital anomaly worldwide. Diagnosis early in pregnancy is important, but the detection rate by two-dimensional ultrasonography is only 65%-81%. OBJECTIVES To evaluate existing data on CHD and noninvasive abdominal fetal electrocardiography (ECG). SEARCH STRATEGY A systematic review was performed through a search of the Cochrane Library, PubMed, and Embase for studies published up to April 2016 using the terms "congenital heart disease," "fetal electrocardiogram," and other similar keywords. SELECTION CRITERIA Primary articles that described changes in fetal ECG among fetuses with CHD published in English were included. DATA COLLECTION AND ANALYSIS Outcomes of interest were changes in fetal ECG parameters observed for fetuses with congenital heart disease. Findings were reported descriptively. MAIN RESULTS Only five studies described changes observed in the fetal electrocardiogram for fetuses with CHD, including heart rate, heart rate variability, and PR, QRS, and QT intervals. Fetal ECG reflects the intimate relationship between the cardiac nerve conduction system and the structural morphology of the heart. It seems particularly helpful in detecting the electrophysiological effects of cardiac anatomic defects (e.g. hypotrophy, hypertrophy, and conduction interruption). CONCLUSIONS Fetal ECG might be a promising clinical tool to complement ultrasonography in the screening program for CHD.
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11
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Abstract
Compared with the assessment of most fetal anatomic structures, the assessment of the fetal heart during routine obstetric screening represents a diagnostic challenge for sonographers and interpreting physicians. This is due to a number of factors: the structural complexity of the heart, the rate at which it moves, the position of the fetus relative to the transducer, and variations in assessment protocols used by sonographers and physicians. The fetal heart is a relatively small and complex structure, as seen in an early second-trimester sonogram. In some forms of congenital heart disease, the abnormality may be detectable within only a relatively small fraction of the heart volume. Congenital heart disease represents a range of structural defects, a number of which have specific sonographic features that can be identified during routine assessment. Many approaches have been proposed to improve the assessment of the fetal heart, including specific still images, color Doppler, 3D imaging techniques, and cineloops.
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Affiliation(s)
- Ted Scott
- Society of Diagnostic Medical Screening Member, Hamilton, Canada
| | | | - Hans Swan
- Charles Sturt University, Wagga Wagga, Australia
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12
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Peyvandi S, De Santiago V, Chakkarapani E, Chau V, Campbell A, Poskitt KJ, Xu D, Barkovich AJ, Miller S, McQuillen P. Association of Prenatal Diagnosis of Critical Congenital Heart Disease With Postnatal Brain Development and the Risk of Brain Injury. JAMA Pediatr 2016; 170:e154450. [PMID: 26902528 PMCID: PMC5083633 DOI: 10.1001/jamapediatrics.2015.4450] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE The relationship of prenatal diagnosis of critical congenital heart disease (CHD) with brain injury and brain development is unknown. Given limited improvement of CHD outcomes with prenatal diagnosis, the effect of prenatal diagnosis on brain health may reveal additional benefits. OBJECTIVE To compare the prevalence of preoperative and postoperative brain injury and the trajectory of brain development in neonates with prenatal vs postnatal diagnosis of CHD. DESIGN, SETTING, AND PARTICIPANTS Cohort study of term newborns with critical CHD recruited consecutively from 2001 to 2013 at the University of California, San Francisco and the University of British Columbia. Term newborns with critical CHD were studied with brain magnetic resonance imaging preoperatively and postoperatively to determine brain injury severity and microstructural brain development with diffusion tensor imaging by measuring fractional anisotropy and the apparent diffusion coefficient. Comparisons of magnetic resonance imaging findings and clinical variables were made between prenatal and postnatal diagnosis of critical CHD. A total of 153 patients with transposition of the great arteries and single ventricle physiology were included in this analysis. MAIN OUTCOMES AND MEASURES The presence of brain injury on the preoperative brain magnetic resonance imaging and the trajectory of postnatal brain microstructural development. RESULTS Among 153 patients (67% male), 96 had transposition of the great arteries and 57 had single ventricle physiology. The presence of brain injury was significantly higher in patients with postnatal diagnosis of critical CHD (41 of 86 [48%]) than in those with prenatal diagnosis (16 of 67 [24%]) (P = .003). Patients with prenatal diagnosis demonstrated faster brain development in white matter fractional anisotropy (rate of increase, 2.2%; 95% CI, 0.1%-4.2%; P = .04) and gray matter apparent diffusion coefficient (rate of decrease, 0.6%; 95% CI, 0.1%-1.2%; P = .02). Patients with prenatal diagnosis had lower birth weight (mean, 3184.5 g; 95% CI, 3050.3-3318.6) than those with postnatal diagnosis (mean, 3397.6 g; 95% CI, 3277.6-3517.6) (P = .02). Those with prenatal diagnosis had an earlier estimated gestational age at delivery (mean, 38.6 weeks; 95% CI, 38.2-38.9) than those with postnatal diagnosis (mean, 39.1 weeks; 95% CI, 38.8-39.5) (P = .03). CONCLUSIONS AND RELEVANCE Newborns with prenatal diagnosis of single ventricle physiology and transposition of the great arteries demonstrate less preoperative brain injury and more robust microstructural brain development than those with postnatal diagnosis. These results are likely secondary to improved cardiovascular stability. The impact of these findings on neurodevelopmental outcomes warrants further study.
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Affiliation(s)
- Shabnam Peyvandi
- Department of Pediatrics, University of California, San Francisco, Benioff Children’s Hospital, San Francisco
| | - Veronica De Santiago
- Department of Pediatrics, University of California, San Francisco, Benioff Children’s Hospital, San Francisco
| | - Elavazhagan Chakkarapani
- School of Clinical Sciences, University of Bristol and St Michael’s Hospital, Bristol, England3Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vann Chau
- Department of Pediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - Andrew Campbell
- Department of Pediatric Cardiovascular and Thoracic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kenneth J. Poskitt
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Duan Xu
- Department of Radiology, University of California, San Francisco, Benioff Children’s Hospital, San Francisco
| | - A. James Barkovich
- Department of Radiology, University of California, San Francisco, Benioff Children’s Hospital, San Francisco
| | - Steven Miller
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada4Department of Pediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - Patrick McQuillen
- Department of Pediatrics, University of California, San Francisco, Benioff Children’s Hospital, San Francisco8Department of Neurology, University of California, San Francisco, Benioff Children’s Hospital, San Francisco
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13
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Tararbit K, Lelong N, Jouannic JM, Goffinet F, Khoshnood B. Is the probability of prenatal diagnosis or termination of pregnancy different for fetuses with congenital anomalies conceived following assisted reproductive techniques? A population-based evaluation of fetuses with congenital heart defects. BJOG 2015; 122:924-31. [DOI: 10.1111/1471-0528.13345] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2015] [Indexed: 11/27/2022]
Affiliation(s)
- K Tararbit
- Inserm UMR 1153; Equipe de recherche en Epidémiologie Obstétricale; Périnatale et Pédiatrique (EPOPé); Centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité DHU Risques et grossesse; Université Paris Descartes; Paris France
| | - N Lelong
- Inserm UMR 1153; Equipe de recherche en Epidémiologie Obstétricale; Périnatale et Pédiatrique (EPOPé); Centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité DHU Risques et grossesse; Université Paris Descartes; Paris France
| | - J-M Jouannic
- Centre Pluridisciplinaire de Diagnostic Prénatal de l'Est Parisien; Pôle de périnatalité; Hôpital Trousseau; Paris France
| | - F Goffinet
- Inserm UMR 1153; Equipe de recherche en Epidémiologie Obstétricale; Périnatale et Pédiatrique (EPOPé); Centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité DHU Risques et grossesse; Université Paris Descartes; Paris France
- Maternité Port Royal; Hôpital Cochin; Hôpitaux Paris Centre; Assistance Publique Hôpitaux de Paris; Paris France
| | - B Khoshnood
- Inserm UMR 1153; Equipe de recherche en Epidémiologie Obstétricale; Périnatale et Pédiatrique (EPOPé); Centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité DHU Risques et grossesse; Université Paris Descartes; Paris France
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van Velzen CL, Clur SA, Rijlaarsdam MEB, Bax CJ, Pajkrt E, Heymans MW, Bekker MN, Hruda J, de Groot CJM, Blom NA, Haak MC. Prenatal detection of congenital heart disease--results of a national screening programme. BJOG 2015; 123:400-7. [PMID: 25625301 DOI: 10.1111/1471-0528.13274] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Congenital heart disease (CHD) is the most common congenital malformation and causes major morbidity and mortality. Prenatal detection improves the neonatal condition before surgery, resulting in less morbidity and mortality. In the Netherlands a national prenatal screening programme was introduced in 2007. This study evaluates the effects of this screening programme. DESIGN Geographical cohort study. SETTING Large referral region of three tertiary care centres. POPULATION Fetuses and infants diagnosed with severe CHD born between 1 January 2002 and 1 January 2012. METHODS Cases were divided into two groups: before and after the introduction of screening. MAIN OUTCOME MEASURES Detection rates were calculated. RESULTS The prenatal detection rate (n = 1912) increased with 23.9% (95% confidence interval [95% CI] 19.5-28.3) from 35.8 to 59.7% after the introduction of screening and of isolated CHD with 21.4% (95% CI 16.0-26.8) from 22.8 to 44.2%. The highest detection rates were found in the hypoplastic left heart syndrome, other univentricular defects and complex defects with atrial isomerism (>93%). Since the introduction of screening, the 'late' referrals (after 24 weeks of gestation) decreased by 24.3% (95% CI 19.3-29.3). CONCLUSIONS This is the largest cohort study to investigate the prenatal detection rate of severe CHD in an unselected population. A nationally organised screening has resulted in a remarkably high detection rate of CHD (59.7%) compared with earlier literature.
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Affiliation(s)
- C L van Velzen
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands
| | - S A Clur
- Department of Pediatric Cardiology, Academic Medical Centre, Emma Children's Hospital, Amsterdam, the Netherlands
| | - M E B Rijlaarsdam
- Department of Paediatric Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - C J Bax
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands
| | - E Pajkrt
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands
| | - M W Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands
| | - M N Bekker
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - J Hruda
- Department of Paediatric Cardiology, VU University Medical Centre, Amsterdam, the Netherlands
| | - C J M de Groot
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands
| | - N A Blom
- Department of Pediatric Cardiology, Academic Medical Centre, Emma Children's Hospital, Amsterdam, the Netherlands.,Department of Paediatric Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - M C Haak
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
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Minimizing the risk of preoperative brain injury in neonates with aortic arch obstruction. J Pediatr 2014; 165:1116-1122.e3. [PMID: 25306190 PMCID: PMC4624274 DOI: 10.1016/j.jpeds.2014.08.066] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 06/19/2014] [Accepted: 08/28/2014] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine whether prenatal diagnosis lowers the risk of preoperative brain injury by assessing differences in the incidence of preoperative brain injury across centers. STUDY DESIGN From 2 prospective cohorts of newborns with complex congenital heart disease studied by preoperative cerebral magnetic resonance imaging, one cohort from the University Medical Center Utrecht (UMCU) and a combined cohort from the University of California San Francisco (UCSF) and University of British Columbia (UBC), patients with aortic arch obstruction were selected and their imaging and clinical course reviewed. RESULTS Birth characteristics were comparable between UMCU (n = 33) and UCSF/UBC (n = 54). Patients had a hypoplastic aortic arch with either coarctation/interruption or hypoplastic left heart syndrome. In subjects with prenatal diagnosis, there was a significant difference in the prevalence of white matter injury (WMI) between centers (11 of 22 [50%] at UMCU vs 4 of 30 [13%] at UCSF/UBC; P < .01). Prenatal diagnosis was protective for WMI at UCSF/UBC (13% prenatal diagnoses vs 50% postnatal diagnoses; P < .01), but not at UMCU (50% vs 46%, respectively; P > .99). Differences in clinical practice between prenatally diagnosed subjects at UMCU vs UCSF/UBC included older age at surgery, less time spent in the intensive care unit, greater use of diuretics, less use of total parenteral nutrition (P < .01), and a greater incidence of infections (P = .01). In patients diagnosed postnatally, the prevalence of WMI was similar in the 2 centers (46% at UMCU vs 50% at UCSF/UBC; P > .99). Stroke prevalence was similar in the 2 centers regardless of prenatal diagnosis (prenatal diagnosis: 4.5% at Utrecht vs 6.7% at UCSF/UBC, P = .75; postnatal diagnosis: 9.1% vs 13%, respectively, P > .99). CONCLUSION Prenatal diagnosis can be protective for WMI, but this protection may be dependent on specific clinical management practices that differ across centers.
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Scott TE, Jones J, Rosenberg H, Thomson A, Ghandehari H, Rosta N, Jozkow K, Stromer M, Swan H. Increasing the detection rate of congenital heart disease during routine obstetric screening using cine loop sweeps. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:973-979. [PMID: 23716518 DOI: 10.7863/ultra.32.6.973] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The purpose of this study was to demonstrate an increase in the detection rate of fetal cardiac defects using 2 cine loop sweeps. METHODS Image reviewers examined a series of 93 cases randomly sorted, including 79 studies with normal findings and 14 studies with abnormal findings. All of the images were assessed by 5 standard criteria. Cases were classified as normal, abnormal, or indeterminate. Reviewers using the conventional approach reviewed 3 still images: the 4-chamber, left ventricular outflow tract, and right ventricular outflow tract views. Reviewers using the cine loop sweeps viewed 2 grayscale sweeps through the fetal heart in real time. The image sequences were reviewed independently by 2 experts, 3 nonexperts, and 2 sonographers blinded to each others' results. RESULTS The cine loop sweeps had an increased detection rate of 38% for the nonexperts and 36% for the experts compared with the conventional approach. The cine loop sweeps allowed identification of all cardiac defects by at least 2 of the 7 reviewers; the percentage of cases with false-positive findings was 3.9%. With the conventional approach, 2 defects went undetected by all reviewers, and 4 defects were found by only 1 reviewer; the percentage of cases with false-positive findings was 5.4%. CONCLUSIONS The use of cine loop sweeps has the potential to increase the detection of fetal cardiac defects without increasing the rate of false-positive findings or increasing the interpretation and decision-making times.
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Affiliation(s)
- Ted E Scott
- Department of Medical Radiation Sciences, Mohawk College, Hamilton, Ontario, Canada.
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Woods P, Browning Carmo K, Wall M, Berry A. Transporting newborns with transposition of the great arteries. J Paediatr Child Health 2013; 49:E68-73. [PMID: 23282145 DOI: 10.1111/jpc.12066] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2012] [Indexed: 11/30/2022]
Abstract
AIMS The aim of the study was to examine the prevalence and management of outborn babies with a post-natally confirmed diagnosis of transposition of the great arteries (TGA) requiring transport by the Newborn and Paediatric Emergency Transport Service (NETS), New South Wales during the epoch 1991-2010. METHOD A retrospective audit of NETS database and case notes. The physiological status, interventions and any complications encountered from the point of referral to NETS (pre-transport), stabilisation (transport) and subsequent admission to the receiving hospital (post-transport) were evaluated. RESULTS One hundred fifty-seven infants with TGA were transported, with an average of eight per year (1:11,598 births). Seven (4%) had an antenatal diagnosis, and 72 (46%) had a post-natal diagnosis prior to referral. Physiological and clinical parameters demonstrated overall clinical stability; however, 47% of the babies had a PaO(2) <30 mmHg, and approximately one-fifth had oxygen saturations <70%. Rates of mechanical ventilation and prostaglandin E(1) administration were approximately 50%. A quarter of transported babies encountered a transport-related event, including one death and two babies for which a decision was reached to forego life-sustaining treatment at the referring hospital. CONCLUSIONS Most newborns with TGA remain stable or improve during transport. There is a rate of adverse events; however, this reinforces the need to facilitate delivery where there is ready access to interventional paediatric cardiology services.
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Affiliation(s)
- Patricia Woods
- Newborn and Paediatric Emergency Transport Service, Sydney Children's Hospitals Network (Westmead), Sydney, New South Wales, Australia.
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Wald RM, Sermer M, Colman JM. Pregnancy and contraception in young women with congenital heart disease: General considerations. Paediatr Child Health 2012; 16:e25-9. [PMID: 22468131 DOI: 10.1093/pch/16.4.e25] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2010] [Indexed: 11/13/2022] Open
Abstract
Young women with heart disease are increasingly being seen in obstetrical referral centres owing, in large part, to the dramatic improvements in survival of young adults with congenital heart disease in recent years. Although pregnancies in most women with heart disease result in favourable outcomes, there are important exceptions that must be recognized. These exceptions pose significant mortality risk to the mother and/or the fetus. The present article outlines cardiovascular adaptations to pregnancy, general outcomes and management considerations for practitioners caring for pregnant young women with congenital heart disease. A lesion-specific review is published in a complementary article.
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Affiliation(s)
- Rachel M Wald
- Toronto General Hospital, Mount Sinai Hospital and Toronto Congenital Cardiac Centre for Adults, University Health Network
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Volpe P, De Robertis V, Campobasso G, Tempesta A, Volpe G, Rembouskos G. Diagnosis of congenital heart disease by early and second-trimester fetal echocardiography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:563-568. [PMID: 22441912 DOI: 10.7863/jum.2012.31.4.563] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The aim of this study was to compare the cardiac findings at 11 to 14 weeks' gestation with the second-trimester findings to evaluate the reliability of first-trimester echocardiography and the possibility of congenital heart disease evolution. METHODS The database of our fetal medicine unit was searched for all patients who had undergone fetal echocardiography at 11 to 14 and 18 to 22 weeks' gestation from 2005 to 2010. In all of the antenatally suspected cases of congenital heart disease, the diagnosis was established conclusively by postnatal echocardiography, surgery, or autopsy. RESULTS Among the 870 fetuses included in the study, 802 were considered to have no abnormalities on both examinations. Thirty-six cases had abnormal findings on both examinations, and 32 had discordant findings. Among the 32 discordant findings, 6 cases had a false-positive diagnosis of congenital heart disease on early echocardiography, and 26 had a different diagnosis. In 14 of these 26 cases, the diagnosis was slightly different on the second-trimester examination, or the defect misdiagnosed in the first trimester was a minor one. In 6 of the remaining 12 fetuses, a major congenital heart disease was missed on the early echocardiography. In 6 cases, the congenital heart disease developed or progressed in severity in the second trimester. CONCLUSIONS First-trimester echocardiography is feasible and seems to allow considerably earlier detection of major congenital heart disease. However, it should be kept in mind that although most forms of heart defects can be diagnosed early in pregnancy, some may develop and become apparent only later in gestation.
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Affiliation(s)
- Paolo Volpe
- Fetal Medicine Unit, Di Venere-Sarcone Hospital, Azienda Sanitaria Locale di Bari, via Ospedale Di Venere, 70100 Bari, Italy.
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Volpe P, Ubaldo P, Volpe N, Campobasso G, Robertis VD, Tempesta A, Volpe G, Rembouskos G. Fetal cardiac evaluation at 11-14 weeks by experienced obstetricians in a low-risk population. Prenat Diagn 2011; 31:1054-61. [DOI: 10.1002/pd.2831] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 06/16/2011] [Accepted: 06/17/2011] [Indexed: 11/06/2022]
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Gilboa SM, Salemi JL, Nembhard WN, Fixler DE, Correa A. Mortality resulting from congenital heart disease among children and adults in the United States, 1999 to 2006. Circulation 2010; 122:2254-63. [PMID: 21098447 PMCID: PMC4911018 DOI: 10.1161/circulationaha.110.947002] [Citation(s) in RCA: 400] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 08/17/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous reports suggest that mortality resulting from congenital heart disease (CHD) among infants and young children has been decreasing. There is little population-based information on CHD mortality trends and patterns among older children and adults. METHODS AND RESULTS We used data from death certificates filed in the United States from 1999 to 2006 to calculate annual CHD mortality by age at death, race-ethnicity, and sex. To calculate mortality rates for individuals ≥1 year of age, population counts from the US Census were used in the denominator; for infant mortality, live birth counts were used. From 1999 to 2006, there were 41,494 CHD-related deaths and 27,960 deaths resulting from CHD (age-standardized mortality rates, 1.78 and 1.20 per 100,000, respectively). During this period, mortality resulting from CHD declined 24.1% overall. Mortality resulting from CHD significantly declined among all race-ethnicities studied. However, disparities persisted; overall and among infants, mortality resulting from CHD was consistently higher among non-Hispanic blacks compared with non-Hispanic whites. Infant mortality accounted for 48.1% of all mortality resulting from CHD; among those who survived the first year of life, 76.1% of deaths occurred during adulthood (≥18 years of age). CONCLUSIONS CHD mortality continued to decline among both children and adults; however, differences between race-ethnicities persisted. A large proportion of CHD-related mortality occurred during infancy, although significant CHD mortality occurred during adulthood, indicating the need for adult CHD specialty management.
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Affiliation(s)
- Suzanne M Gilboa
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Mail Stop E-86, 1600 Clifton Rd, Atlanta, GA 30333, USA.
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Martínez JM, Gómez O, Bennasar M, Olivella A, Crispi F, Puerto B, Gratacós E. The 'question mark' sign as a new ultrasound marker of tetralogy of Fallot in the fetus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:556-560. [PMID: 20205151 DOI: 10.1002/uog.7614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To describe a new ultrasonographic marker, the 'question-mark' sign, to assist in the diagnosis of tetralogy of Fallot (TOF) in the fetus, and to evaluate its prevalence in TOF as compared with other cardiac defects. METHODS A prospective evaluation over a 5-year period of a consecutive series of 3998 pregnant women undergoing fetal echocardiography from 12 to 40 weeks' gestation due to high risk for congenital heart disease (CHD). Standard echocardiographic planes with color Doppler assessment and evaluation of the whole aortic arch, from the left ventricular outflow tract to the descending aorta in the axial upper mediastinum views, were performed. The question-mark sign corresponded with an enlarged and dilated ascending aorta and aortic arch in the three-vessel view of the upper fetal mediastinum. The frequency of this sign was evaluated in cases with TOF and in other cases of cardiac defects, as well as in fetuses with normal cardiac scans in this series. RESULTS CHD was diagnosed in a total of 447 (11.2%) fetuses at a median gestational age of 24 (range, 12-40) weeks. Forty-two of the 447 (9.4%) had TOF, of which 29 cases (69.0%) had classical TOF (pulmonary stenosis), nine (21.4%) pulmonary atresia and four (9.5%) absent pulmonary valve syndrome. A question-mark sign was observed in 16/29 (55.2%) cases of classical TOF and in 8/9 (88.9%) cases of TOF with pulmonary atresia. The sign was never observed in any of the cases of TOF with a right-sided aortic arch. Likewise, the sign was observed in 1/405 (0.2%) cases with other cardiac anomalies (a fetus with a complex cardiac defect) and in none of the fetuses with normal hearts. CONCLUSIONS The finding of an enlarged aorta with a question-mark shape should raise a strong suspicion of tetralogy of Fallot, in particular the variant with pulmonary atresia. This sign may be useful in screening considering that prenatal diagnosis of TOF by routine ultrasonography remains a challenge.
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Affiliation(s)
- J M Martínez
- Maternal-Fetal Medicine Department, Institut Clínic de Ginecologia, Obstetrícia I Neonatologia (ICGON), Hospital Clínic, University of Barcelona, Barcelona, Spain.
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Martínez JM, Comas M, Borrell A, Bennasar M, Gómez O, Puerto B, Gratacós E. Abnormal first-trimester ductus venosus blood flow: a marker of cardiac defects in fetuses with normal karyotype and nuchal translucency. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:267-272. [PMID: 20052662 DOI: 10.1002/uog.7544] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To evaluate the independent contribution of ductus venosus (DV) blood flow assessment at 11-14 weeks' gestation to the prediction of congenital heart defects (CHD) in chromosomally normal fetuses, irrespective of the value of the nuchal translucency thickness (NT). METHODS During a 4-year period, all singleton pregnancies from 11 + 0 to 13 + 6 weeks' gestation were scanned for NT and DV blood flow in a tertiary center. Abnormal DV blood flow was defined as either absent or reversed flow during atrial contraction (AR-DV). Fetal echocardiography was performed in all cases with either NT > 99(th) percentile or AR-DV. Follow-up was assessed by postnatal examination or autopsy in cases of termination of pregnancy or perinatal death. RESULTS A total of 6120 pregnancies were scanned at a median gestational age of 12 weeks, and 45 cases of CHD were detected. AR-DV was found in 206 fetuses, of which 145 (70.4%) had a normal karyotype. Among fetuses with AR-DV and normal karyotype, 11 cases of CHD were diagnosed, giving a sensitivity of 24.4%, a positive predictive value of 7.6% and an odds ratio of 9.8. Increased NT (> 99(th) centile) was present in 55 of the 145 (37.9%) cases with AR-DV and normal karyotype, and in 6/11 (54.5%) of those with CHD. Thus, the group of 90 fetuses with abnormal DV blood flow and normal NT contained five cases of CHD, for a sensitivity of 11.1%, a positive predictive value of 5.5% and an odds ratio of 8.5. Right-heart anomalies were predominant in those cases with isolated AR-DV (4/5), but no specific CHD pattern was found in those with increased NT. The detection rate of CHD by the combined use of increased NT and/or AR-DV in the first trimester improved from 28.9% (13/45) to 40.0% (18/45). CONCLUSIONS In experienced hands, abnormal DV blood flow in the first trimester is an independent predictor of CHD and should constitute an indication for early echocardiography. In this study, the use of DV blood flow assessment increased early detection of CHD by 11% with respect to the use of NT measurement alone.
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Affiliation(s)
- J M Martínez
- Fetal-Maternal Medicine Service, ICGON, Hospital Clínic, University of Barcelona, Barcelona, Spain.
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Arcelli D, Farina A, Cappuzzello C, Bresin A, De Sanctis P, Perolo A, Prandstraller D, Valentini D, Zucchini C, Priori S, Rizzo N. Identification of circulating placental mRNA in maternal blood of pregnancies affected with fetal congenital heart diseases at the second trimester of pregnancy: implications for early molecular screening. Prenat Diagn 2010; 30:229-34. [DOI: 10.1002/pd.2443] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Chromosomal anomalies influence parental treatment decisions in relation to prenatally diagnosed congenital heart disease. Pediatr Cardiol 2009; 30:1105-11. [PMID: 19705187 PMCID: PMC4356125 DOI: 10.1007/s00246-009-9514-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Revised: 06/15/2009] [Accepted: 07/31/2009] [Indexed: 01/08/2023]
Abstract
This study aimed to identify the variables that influence parental treatment decisions after a prenatal diagnosis of congenital heart disease (CHD). The authors reviewed all cases of prenatally diagnosed structural CHD from August 1998 to December 2006 at their center. The following variables were studied as potential predictors of parental intent to treat: maternal age, race, insurance status, obstetric history, fetal gender, univentricular versus biventricular cardiac physiology, and fetal chromosomal abnormality. Uni- and multivariable logistic regression analyses were performed. In the review, 252 consecutive cases of prenatally diagnosed CHD were identified. Of these, 204 women pursued full medical treatment, whereas 25 women sought termination of pregnancy or comfort care. Parental intent to treat was unknown for 23 cases. Multivariable logistic regression analysis identified fetal chromosomal abnormality as the only variable that influenced parental intent to treat (odds ratio [OR], 14.33; 95% confidence interval [CI], 3.28-62.66; p = 0.0006). An associated chromosomal abnormality rather than the severity of the heart defect influences the decision to choose termination of pregnancy or comfort care for a fetus with prenatally diagnosed CHD. Women were 14 times more likely to terminate a pregnancy or seek comfort care for a fetus with CHD if a chromosomal abnormality was present.
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ALGERT CS, BOWEN JR, HADFIELD RM, OLIVE EC, MORRIS JM, ROBERTS CL. Birth at hospitals with co-located paediatric units for infants with correctable birth defects. Aust N Z J Obstet Gynaecol 2008; 48:273-9. [DOI: 10.1111/j.1479-828x.2008.00838.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bibliography. Current world literature. Cardiovascular medicine. Curr Opin Pediatr 2007; 19:601-6. [PMID: 17885483 DOI: 10.1097/mop.0b013e3282f12851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bibliography. Current world literature. Maternal-fetal medicine. Curr Opin Obstet Gynecol 2007; 19:196-201. [PMID: 17353689 DOI: 10.1097/gco.0b013e32812142e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chen YY, Hsu CY. Prenatal diagnosis and antenatal history of total anomalous pulmonary venous return. Taiwan J Obstet Gynecol 2006; 45:283-5. [PMID: 17175483 DOI: 10.1016/s1028-4559(09)60244-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Total anomalous pulmonary venous return (TAPVR) is traditionally diagnosed by echocardiography or cardiac catheterization postnatally after the appearance of clinical signs. We report a case of TAPVR diagnosed prenatally by targeted echocardiography. CASE REPORT A 17-year-old woman was referred at 34 weeks of gestation because of persistent bradycardia. Echocardiography showed atrial disproportion and no direct pulmonary venous return to the left atrium. A female infant was delivered by cesarean section at 38 weeks of gestation. Echocardiography and cardiac catheterization were arranged soon after delivery and TAPVR was confirmed. The infant underwent surgical repair of TAPVR by anastomosis between the left atrium and pulmonary venous confluence as well as surgical ligation of the patent ductus arteriosus at the age of 2 days. The infant died on the 28th postoperative day due to obstruction of pulmonary venous return and respiratory failure. CONCLUSION With advances in sonographic equipment and careful evaluation of cardiac structures, it is possible to diagnose TAPVR prenatally. Pulmonary venous anatomy should be checked during prenatal examination.
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Affiliation(s)
- Yi-Yung Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
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Abstract
PURPOSE OF REVIEW The present review summarizes the prenatal and postnatal outcome of cardiac anomalies and sustained arrhythmias diagnosed during fetal life. RECENT FINDINGS The outcome of sustained fetal arrhythmias has improved with greater experience using Sotalol for atrial flutter, and digoxin and amiodarone for 1: 1 reciprocating tachycardia. The outcome of fetal conduction system disease secondary to maternal Sjögren's antibodies has noticeably improved with transplacental dexamethasone. The postnatal prognosis for atrioventricular block associated with left atrial isomerism, however, remains very bleak. Assessing the effect of prenatal diagnosis on the outcome of structural defects remains difficult because of the high number of extracardiac anomalies and chromosome defects in this group. Preoperative survival is improved, but postoperative mortality has not improved. One clear advantage of prenatal diagnosis is the selection of fetuses that may benefit from in-utero intervention to limit the progression of their disease or lessen its severity at birth. SUMMARY For the most part, postoperative mortality of structural cardiac defects is not significantly improved by prenatal diagnosis. In-utero management of tachyarrhythmias and conduction system disease has improved postnatal outcome, except for the fetus with atrioventricular block and left atrial isomerism.
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Affiliation(s)
- Bettina F Cuneo
- The Heart Institute for Children, Department of Pediatrics, Rush Medical College, and Hope Children's Hospital, 440 W. 95th Street, Oak Lawn, IL 60453, USA.
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McGrath JM. Early detection and immediate management of congenital heart disease is important to long-term outcomes. J Perinat Neonatal Nurs 2006; 20:285-6. [PMID: 17310667 DOI: 10.1097/00005237-200610000-00004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jaquiss RDB, Tweddell JS. The neonate with congenital heart disease: what the cardiac surgeon needs to know from the neonatologist and the cardiologist. Clin Perinatol 2005; 32:947-61, ix. [PMID: 16325671 DOI: 10.1016/j.clp.2005.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To plan and accomplish a successful operation for a neonate with congenital heart disease, the cardiac surgeon requires a complete anatomic description of the cardiovascular malformation. For optimum outcome, this information must be supplemented by a complete report of the prenatal and postnatal course of the newborn as well as by a thorough summary of any noncardiac congenital or acquired abnormalities. In the most favorable circumstance, the neonate arrives in the operating room completely diagnosed, fully resuscitated, well nourished, and with appropriate monitoring devices in place. Unique perioperative considerations attach to each cardiac anomaly and are briefly reviewed, and the importance of continuity of care for the patient and family is emphasized.
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Affiliation(s)
- Robert D B Jaquiss
- Medical College of Wisconsin, 9000 West Wisconsin Avenue, MS 715, Milwaukee, WI 53221, USA.
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Current awareness in prenatal diagnosis. Prenat Diagn 2005; 25:429-34. [PMID: 15948307 DOI: 10.1002/pd.1019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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