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Zhou X, He J, Kuang H, Fang J, Wang H. Perinatal deaths attributable to congenital heart defects in Hunan Province, China, 2016-2020. PLoS One 2024; 19:e0304615. [PMID: 38870227 PMCID: PMC11175501 DOI: 10.1371/journal.pone.0304615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 05/15/2024] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVE To explore the association between demographic characteristics and perinatal deaths attributable to congenital heart defects (CHDs). METHODS Data were obtained from the Birth Defects Surveillance System of Hunan Province, China, 2016-2020. The surveillance population included fetuses and infants from 28 weeks of gestation to 7 days after birth whose mothers delivered in the surveillance hospitals. Surveillance data included demographic characteristics such as sex, residence, maternal age, and other key information, and were used to calculate the prevalence of CHDs and perinatal mortality rates (PMR) with 95% confidence intervals (CI). Multivariable logistic regression analysis (method: Forward, Wald, α = 0.05) and adjusted odds ratios (ORs) were used to identify factors associated with perinatal deaths attributable to CHDs. RESULTS This study included 847755 fetuses, and 4161 CHDs were identified, with a prevalence of 0.49% (95%CI: 0.48-0.51). A total of 976 perinatal deaths attributable to CHDs were identified, including 16 (1.64%) early neonatal deaths and 960 (98.36%) stillbirths, with a PMR of 23.46% (95%CI: 21.98-24.93). In stepwise logistic regression analysis, perinatal deaths attributable to CHDs were more common in rural areas than urban areas (OR = 2.21, 95%CI: 1.76-2.78), more common in maternal age <20 years (OR = 2.40, 95%CI: 1.05-5.47), 20-24 years (OR = 2.13, 95%CI: 1.46-3.11) than maternal age of 25-29 years, more common in 2 (OR = 1.60, 95%CI: 1.18-2.18) or 3 (OR = 1.43, 95%CI: 1.01-2.02) or 4 (OR = 1.84, 95%CI: 1.21-2.78) or > = 5 (OR = 2.02, 95%CI: 1.28-3.18) previous pregnancies than the first pregnancy, and more common in CHDs diagnosed in > = 37 gestional weeks (OR = 77.37, 95%CI: 41.37-144.67) or 33-36 gestional weeks (OR = 305.63, 95%CI: 172.61-541.15) or < = 32 gestional weeks (OR = 395.69, 95%CI: 233.23-671.33) than diagnosed in postnatal period (within 7 days), and less common in multiple births than singletons (OR = 0.48, 95%CI: 0.28-0.80). CONCLUSIONS Perinatal deaths were common in CHDs in Hunan in 2016-2020. Several demographic characteristics were associated with perinatal deaths attributable to CHDs, which may be summarized mainly as economic and medical conditions, severity of CHDs, and parental attitudes toward CHDs.
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Affiliation(s)
- Xu Zhou
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Jian He
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Haiyan Kuang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Junqun Fang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Hua Wang
- The Hunan Children’s Hospital, Changsha, Hunan Province, China
- National Health Commission Key Laboratory of Birth Defects Research, Prevention and Treatment, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
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Bucholz EM, Lu M, Sleeper L, Vergales J, Bingler MA, Ronai C, Anderson JB, Bates KE, Lannon C, Reynolds L, Brown DW. Risk Factors for Death or Transplant After Stage 2 Palliation for Single Ventricle Heart Disease. JACC. ADVANCES 2024; 3:100934. [PMID: 38939642 PMCID: PMC11198479 DOI: 10.1016/j.jacadv.2024.100934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/30/2023] [Accepted: 01/25/2024] [Indexed: 06/29/2024]
Abstract
Background For infants with single ventricle heart disease, the time after stage 2 procedure (S2P) is believed to be a lower risk period compared with the interstage period; however, significant morbidity and mortality still occur. Objectives This study aimed to identify risk factors for mortality or transplantation referral between S2P surgery and the first birthday. Methods Retrospective cohort analysis of infants in the National Pediatric Cardiology Quality Improvement Collaborative who underwent staged single ventricle palliation from 2016 to 2022 and survived to S2P. Multivariable logistic regression and classification and regression trees were performed to identify risk factors for mortality and transplantation referral after S2P. Results Of the 1,455 patients in the cohort who survived to S2P, 5.2% died and 2.3% were referred for transplant. Overall event rates at 30 and 100 days after S2P were 2% and 5%, respectively. Independent risk factors for mortality and transplantation referral included the presence of a known genetic syndrome, shunt type at stage 1 procedure (S1P), tricuspid valve repair at S1P, longer time to extubation and reintubation after S1P, ≥ moderate tricuspid regurgitation prior to S2P, younger age at S2P, and the risk groups identified in the classification and regression tree analysis (extracorporeal membrane oxygenation after S1P and longer S2P cardiopulmonary bypass time without extracorporeal membrane oxygenation). Conclusions Mortality and transplantation referral rates after S2P to 1 year of age remain high ∼7%. Many of the identified risk factors after S2P are similar to those established for interstage factors around the S1P, whereas others may be unique to the period after S2P.
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Affiliation(s)
- Emily M. Bucholz
- Section of Cardiology, Department of Pediatrics, Children’s Hospital of Colorado and the University of Colorado School of Medicine, Denver, Colorado, USA
| | - Minmin Lu
- Department of Cardiology, Boston Children’s Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Lynn Sleeper
- Department of Cardiology, Boston Children’s Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey Vergales
- Division of Pediatric Cardiology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | | | - Christina Ronai
- Department of Cardiology, Boston Children’s Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey B. Anderson
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Katherine E. Bates
- Congenital Heart Center, University of Michigan C.S. Mott Children’s Hospital, Ann Arbor, Michigan, USA
| | - Carole Lannon
- Congenital Heart Center, University of Michigan C.S. Mott Children’s Hospital, Ann Arbor, Michigan, USA
| | - Lindsey Reynolds
- Department of Cardiology, Boston Children’s Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - David W. Brown
- Department of Cardiology, Boston Children’s Hospital, and Harvard Medical School, Boston, Massachusetts, USA
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Böckenhoff P, Hellmund A, Gottschalk I, Berg C, Herberg U, Geipel A, Gembruch U. Prenatal Diagnosis, Associated Findings, and Postnatal Outcome in Fetuses with Double Inlet Ventricle (DIV). ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:e226-e240. [PMID: 35777369 PMCID: PMC10575714 DOI: 10.1055/a-1866-4538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To assess the spectrum of associated cardiac anomalies, the intrauterine course, and postnatal outcome of fetuses with double inlet ventricle (DIV). METHODS Retrospective analysis of prenatal ultrasound of 35 patients with DIV diagnosed between 2003 and 2021 in two tertiary referral centers in Germany. All fetuses underwent fetal echocardiography and a detailed anomaly scan. Postnatal outcome and follow-up data were retrieved from pediatric reports. RESULTS 33 cases of DIV were correctly diagnosed prenatally. 24 fetuses (72.7%) had a double inlet ventricle with dominant left (DILV), 7 (21.2%) with dominant right ventricular morphology (DIRV), and 2 cases (6%) with indeterminate morphology (DIIV). 4 (16.6%) were Holmes hearts. 5 of the 7 fetuses (71.4%) with DIRV had a double outlet right ventricle (DORV). Malposition of the great arteries was present in 84.8%. Chromosomal abnormalities were absent. Termination of pregnancy was performed in 8 cases (24.2%). 24 fetuses (72.7%) were live-born. 5 (20.8%) were female and 19 (79.2%) were male. The median gestational age at birth was 38+2.5 weeks. All but one child received univentricular palliation. The median follow-up time was 5.83 years with an adjusted survival rate of 91.6% (22 of 24 live-born children). There was one case of Fontan failure at 15.7 years. CONCLUSION DIV remains a major cardiac malformation although both prenatal diagnostics and cardiac surgery have improved over the years. The course of pregnancy is commonly uneventful. All children need univentricular palliation. The children are slightly physically limited, develop a normal intellect, and attend school regularly.
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Affiliation(s)
- Paul Böckenhoff
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Astrid Hellmund
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Ingo Gottschalk
- Department of Prenatal Medicine und Gynecological Sonography, University Hospital Cologne, Cologne, Germany
| | - Christoph Berg
- Department of Prenatal Medicine und Gynecological Sonography, University Hospital Cologne, Cologne, Germany
| | - Ulrike Herberg
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
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Miller HE, Fraz F, Zhang J, Henkel A, Leonard SA, Maskatia SA, El-Sayed YY, Blumenfeld YJ. Abortion Bans and Resource Utilization for Congenital Heart Disease: A Decision Analysis. Obstet Gynecol 2023; 142:652-659. [PMID: 37535962 DOI: 10.1097/aog.0000000000005291] [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: 03/20/2023] [Accepted: 06/01/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To investigate the implications of potential national abortion ban scenarios on the incidence of neonatal single-ventricle cardiac defects. METHODS A decision tree model was developed to predict the incidence of neonatal single-ventricle cardiac defects and related outcomes in the United States under four theoretical national abortion bans: 1) abortion restrictions in existence immediately before the June 2022 Dobbs v Jackson Women's Health Organization Supreme Court decision, 2) 20 weeks of gestation, 3) 13 weeks of gestation, and 4) a complete abortion ban. The model included incidence of live births of neonates with single-ventricle cardiac defects, neonatal heart surgery (including heart transplant and extracorporeal membrane oxygenation [ECMO]), and neonatal death. Cohort size was based on national pregnancy incidence and different algorithm decision point probabilities were aggregated from the existing literature. Monte Carlo simulations were conducted with 10,000 iterations per model. RESULTS In the scenario before the Dobbs decision, an estimated 6,369,000 annual pregnancies in the United States resulted in 1,006 annual cases of single-ventricle cardiac defects. Under a complete abortion ban, the model predicted a 53.7% increase in single-ventricle cardiac defects, or an additional 9 cases per 100,000 live births. This increase would result in an additional 531 neonatal heart surgeries, 16 heart transplants, 77 ECMO utilizations, and 102 neonatal deaths annually. More restrictive gestational age-based bans are predicted to confer increases in cases of neonatal single-ventricle cardiac defects and related adverse outcomes as well. CONCLUSION Universal abortion bans are estimated to increase the incidence of neonatal single-ventricle cardiac defects, associated morbidity, and resource utilization. States considering limiting abortion should consider the implications on the resources required to care for increasing number of children that will be born with significant and complex medical needs, including those with congenital heart disease.
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Affiliation(s)
- Hayley E Miller
- Division of Maternal-Fetal Medicine and Obstetrics and the Division of Family Planning Services and Research, Department of Obstetrics and Gynecology, and the Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, and the Department of Obstetrics and Gynecology, Stanford University, Stanford, California
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Jepson BM, Metz TD, Miller TA, Son SL, Ou Z, Presson AP, Nance A, Pinto NM. Pregnancy loss in major fetal congenital heart disease: incidence, risk factors and timing. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:75-87. [PMID: 37099500 DOI: 10.1002/uog.26231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/09/2023] [Accepted: 04/14/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE Fetuses with congenital heart disease (CHD) are at increased risk of pregnancy loss compared with the general population. We aimed to assess the incidence, timing and risk factors of pregnancy loss in cases with major fetal CHD, overall and according to cardiac diagnosis. METHODS This was a retrospective, population-level cohort study of fetuses and infants diagnosed with major CHD between 1997 and 2018 identified by the Utah Birth Defect Network (UBDN), excluding cases with termination of pregnancy and minor cardiovascular diagnoses (e.g. isolated aortic/pulmonary pathology and isolated septal defects). The incidence and timing of pregnancy loss were recorded, overall and according to CHD diagnosis, with further stratification based on presence of isolated CHD vs additional fetal diagnosis (genetic diagnosis and/or extracardiac malformation). Adjusted risk of pregnancy loss was calculated and risk factors were assessed using multivariable models for the overall cohort and prenatal diagnosis subgroup. RESULTS Of 9351 UBDN cases with a cardiovascular code, 3251 cases with major CHD were identified, resulting in a study cohort of 3120 following exclusion of cases with pregnancy termination (n = 131). There were 2956 (94.7%) live births and 164 (5.3%) cases of pregnancy loss, which occurred at a median gestational age of 27.3 weeks. Of study cases, 1848 (59.2%) had isolated CHD and 1272 (40.8%) had an additional fetal diagnosis, including 736 (57.9%) with a genetic diagnosis and 536 (42.1%) with an extracardiac malformation. The observed incidence of pregnancy loss was highest in the presence of mitral stenosis (< 13.5%), hypoplastic left heart syndrome (HLHS) (10.7%), double-outlet right ventricle with normally related great vessels or not otherwise specified (10.5%) and Ebstein's anomaly (9.9%). The adjusted risk of pregnancy loss was 5.3% (95% CI, 3.7-7.6%) in the overall CHD population and 1.4% (95% CI, 0.9-2.3%) in cases with isolated CHD (adjusted risk ratio, 9.0 (95% CI, 6.0-13.0) and 2.0 (95% CI, 1.0-6.0), respectively, based on the general population risk of 0.6%). On multivariable analysis, variables associated with pregnancy loss in the overall CHD population included female fetal sex (adjusted odds ratio (aOR), 1.6 (95% CI, 1.1-2.3)), Hispanic ethnicity (aOR, 1.6 (95% CI, 1.0-2.5)), hydrops (aOR, 6.7 (95% CI, 4.3-10.5)) and additional fetal diagnosis (aOR, 6.3 (95% CI, 4.1-10)). On multivariable analysis of the prenatal diagnosis subgroup, years of maternal education (aOR, 1.2 (95% CI, 1.0-1.4)), presence of an additional fetal diagnosis (aOR, 2.7 (95% CI, 1.4-5.6)), atrioventricular valve regurgitation ≥ moderate (aOR, 3.6 (95% CI, 1.3-8.8)) and ventricular dysfunction (aOR, 3.8 (95% CI, 1.2-11.1)) were associated with pregnancy loss. Diagnostic groups associated with pregnancy loss were HLHS and variants (aOR, 3.0 (95% CI, 1.7-5.3)), other single ventricles (aOR, 2.4 (95% CI, 1.1-4.9)) and other (aOR, 0.1 (95% CI, 0-0.97)). Time-to-pregnancy-loss analysis demonstrated a steeper survival curve for cases with an additional fetal diagnosis, indicating a higher rate of pregnancy loss compared to cases with isolated CHD (P < 0.0001). CONCLUSIONS The risk of pregnancy loss is higher in cases with major fetal CHD compared with the general population and varies according to CHD type and presence of additional fetal diagnoses. Improved understanding of the incidence, risk factors and timing of pregnancy loss in CHD cases should inform patient counseling, antenatal surveillance and delivery planning. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- B M Jepson
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - T D Metz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - T A Miller
- Division of Pediatric Cardiology, Maine Medical Center, Portland, ME, USA
| | - S L Son
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado, Aurora, CO, USA
| | - Z Ou
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - A P Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - A Nance
- Utah Birth Defect Network, Office of Children with Special Healthcare Needs, Division of Family Health, Utah Department of Health and Human Services, Salt Lake City, UT, USA
| | - N M Pinto
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
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Ramcharan T, Quintero DB, Stickley J, Poole E, Miller P, Desai T, Harris M, Kilby MD, Stumper O, Khan N, Barron DJ, Seale AN. Medium-term Outcome of Prenatally Diagnosed Hypoplastic Left-Heart Syndrome and Impact of a Restrictive Atrial Septum Diagnosed in-utero. Pediatr Cardiol 2023:10.1007/s00246-023-03184-z. [PMID: 37219587 DOI: 10.1007/s00246-023-03184-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/12/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Surgical outcome data differs from overall outcomes of prenatally diagnosed fetuses with hypoplastic left heart syndrome (HLHS). Our aim was to describe outcome of prenatally diagnosed fetuses with this anomaly. METHODS Retrospective review of prenatally diagnosed classical HLHS at a tertiary hospital over a 13-year period, estimated due dates 01/08/2006 to 31/12/2019. HLHS-variants and ventricular disproportion were excluded. RESULTS 203 fetuses were identified with outcome information available for 201. There were extra-cardiac abnormalities in 8% (16/203), with genetic variants in 14% of those tested (17/122). There were 55 (27%) terminations of pregnancy, 5 (2%) intrauterine deaths and 10 (5%) babies had prenatally planned compassionate care. There was intention to treat (ITT) in the remaining 131/201(65%). Of these, there were 8 neonatal deaths before intervention, two patients had surgery in other centers. Of the other 121 patients, Norwood procedure performed in 113 (93%), initial hybrid in 7 (6%), and 1 had palliative coarctation stenting. Survival for the ITT group from birth at 6-months, 1-year and 5-years was 70%, 65%, 62% respectively. Altogether of the initial 201 prenatally diagnosed fetuses, 80 patients (40%) are currently alive. A restrictive atrial septum (RAS) is an important sub-category associated with death, HR 2.61, 95%CI 1.34-5.05, p = 0.005, with only 5/29 patients still alive. CONCLUSION Medium-term outcomes of prenatally diagnosed HLHS have improved however it should be noted that almost 40% do not get to surgical palliation, which is vital to those doing fetal counselling. There remains significant mortality particularly in fetuses with in-utero diagnosed RAS.
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Affiliation(s)
- Tristan Ramcharan
- Heart Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Diana B Quintero
- Heart Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - John Stickley
- Heart Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Esther Poole
- Heart Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Paul Miller
- Heart Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Tarak Desai
- Heart Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Michael Harris
- Heart Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Mark D Kilby
- Fetal Medicine Centre, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Medical Genomics Research Group, Granta Park, Illumina, Cambridge, UK
| | - Oliver Stumper
- Heart Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Natasha Khan
- Heart Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - David J Barron
- Heart Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Anna N Seale
- Heart Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
- Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
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Screening and diagnostic imaging at centres performing congenital heart surgery in middle-income countries. Cardiol Young 2022; 33:780-786. [PMID: 35684953 DOI: 10.1017/s1047951122001731] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Surgical care for CHD is increasingly available in low- and middle-income countries, and efforts to optimise outcomes are growing. This study characterises cardiac imaging and prenatal diagnosis infrastructure in this setting. METHODS An infrastructure survey was administered to sites participating in the International Quality Improvement Collaborative for CHD. Questions regarding transthoracic, transesophageal and epicardial echocardiography, cardiac CT, cardiac magnetic resonance, prenatal screening and fetal echocardiography were included. Associations with in-hospital and 30-day mortality were assessed. RESULTS Thirty-seven sites in 17 countries responded. Programme size and geography varied considerably: < 250 cases (n = 13), 250-500 cases (n = 9), > 500 cases (n = 15); Americas (n = 13), Asia (n = 18), and Eastern Europe (n = 6). All had access to transthoracic echo. Most reported transesophageal and epicardial echocardiography availability (86 and 89%, respectively). Most (81%) had cardiac CT, but only 54% had cardiac magnetic resonance. A third reported impediments to imaging, including lack of portable machines, age/size-appropriate equipment and advanced cardiac imaging access and training. Only 19% of centres reported universal prenatal CHD screening in their catchment area, and only 46% always performed fetal echocardiography if screening raised concern for CHD. No statistically significant associations were identified between imaging modality availability and surgical outcomes. CONCLUSIONS Although access to echocardiography is available in most middle-income countries; advanced imaging modalities (cardiac CT and magnetic resonance) are not always accessible. Prenatal screening for CHD is low, and availability of fetal echocardiography is limited. Imaging infrastructure in low- and middle-income countries and associations with outcomes merits additional study.
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Tulzer A, Arzt W, Gitter R, Sames‐Dolzer E, Kreuzer M, Mair R, Tulzer G. Valvuloplasty in 103 fetuses with critical aortic stenosis: outcome and new predictors for postnatal circulation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:633-641. [PMID: 34605096 PMCID: PMC9324970 DOI: 10.1002/uog.24792] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To review our experience with fetal aortic valvuloplasty (FAV) in fetuses with critical aortic stenosis (CAS) and evolving hypoplastic left heart syndrome (eHLHS), including short- and medium-term postnatal outcome, and to refine selection criteria for FAV by identifying preprocedural predictors of biventricular (BV) outcome. METHODS This was a retrospective review of all fetuses with CAS and eHLHS undergoing FAV at our center between December 2001 and September 2020. Echocardiograms and patient charts were analyzed for pre-FAV ventricular and valvular dimensions and hemodynamics and for postnatal procedures and outcomes. The primary endpoints were type of circulation 28 days after birth and at 1 year of age. Classification and regression-tree analysis was performed to investigate the predictive capacity of pre-FAV parameters for BV circulation at 1 year of age. RESULTS During the study period, 103 fetuses underwent 125 FAVs at our center, of which 87.4% had a technically successful procedure. Technical success per fetus was higher in the more recent period (from 2014) than in the earlier period (96.2% (51/53) vs 78.0% (39/50); P = 0.0068). Eighty fetuses were liveborn after successful intervention and received further treatment. BV outcome at 1 year of age was achieved in 55% of liveborn patients in our cohort after successful FAV, which is significantly higher than the BV-outcome rate (23.7%) in a previously published natural history cohort fulfilling the same criteria for eHLHS (P = 0.0015). Decision-tree analysis based on the ratio of right to left ventricular (RV/LV) length combined with LV pressure (mitral valve regurgitation maximum velocity (MR-Vmax)) had a sensitivity of 96.97% and a specificity of 94.44% for predicting BV outcome without signs of pulmonary arterial hypertension at 1 year of age. The highest probability for a BV outcome was reached for fetuses with a pre-FAV RV/LV length ratio of < 1.094 (96.4%) and for those fetuses with a RV/LV length ratio ≥ 1.094 to < 1.135 combined with a MR-Vmax of ≥ 3.14 m/s (100%). CONCLUSIONS FAV could be performed with high success rates and an acceptable risk with improving results after a learning curve. Pre-FAV RV/LV length ratio combined with LV pressure estimates were able to predict a successful BV outcome at 1 year of age with high sensitivity and specificity. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A. Tulzer
- Children's Heart Center Linz, Department of Pediatric CardiologyKepler University Hospital, Medical Faculty of the Johannes Kepler UniversityLinzAustria
| | - W. Arzt
- Institute of Prenatal Medicine, Kepler University Hospital, Medical Faculty of the Johannes Kepler UniversityLinzAustria
| | - R. Gitter
- Children's Heart Center Linz, Department of Pediatric CardiologyKepler University Hospital, Medical Faculty of the Johannes Kepler UniversityLinzAustria
| | - E. Sames‐Dolzer
- Children's Heart Center Linz, Department of Pediatric Cardiac SurgeryKepler University Hospital, Medical Faculty of the Johannes Kepler UniversityLinzAustria
| | - M. Kreuzer
- Children's Heart Center Linz, Department of Pediatric Cardiac SurgeryKepler University Hospital, Medical Faculty of the Johannes Kepler UniversityLinzAustria
| | - R. Mair
- Children's Heart Center Linz, Department of Pediatric Cardiac SurgeryKepler University Hospital, Medical Faculty of the Johannes Kepler UniversityLinzAustria
| | - G. Tulzer
- Children's Heart Center Linz, Department of Pediatric CardiologyKepler University Hospital, Medical Faculty of the Johannes Kepler UniversityLinzAustria
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Freud LR, Seed M. Prenatal Diagnosis and Management of Single Ventricle Heart Disease. Can J Cardiol 2022; 38:897-908. [DOI: 10.1016/j.cjca.2022.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/27/2022] [Accepted: 04/04/2022] [Indexed: 12/18/2022] Open
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d'Udekem Y, Hutchinson D. Being Born with a Single Cardiac Ventricle: What Do We Tell Prospective Parents. Prenat Diagn 2022; 42:411-418. [PMID: 35278231 DOI: 10.1002/pd.6121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/19/2021] [Accepted: 10/24/2021] [Indexed: 11/07/2022]
Abstract
Being born with a single ventricle remains one of the most extreme congenital cardiac conditions. It encompasses a wide variety of lesions characterized by the existence of one small ventricular cavity. To allow survival, these patients must undergo a series of operations in the first years of life. It was long considered that the success of these interventions would be short-lived and that only a few of these patients would live beyond adulthood. The last decade has seen publication of multiple large outcomes researches on this population, and we now realize that its survival is longer than expected, but with a considerable burden of disease. As a consequence, the size of this single ventricle population is growing rapidly. As primary conveyer of the information on the future of these babies, obstetricians need to be aware of these changes in perspective. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yves d'Udekem
- Division of Cardiac Surgery, Children's National Hospital and Children's National Heart Institute, Washington, DC
| | - Darren Hutchinson
- Department of Cardiology, The Royal Children's Hospital Melbourne and Fetal Cardiology Unit, The Royal Women's Hospital Melbourne, Melbourne, Australia
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11
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Khatib N, Bronshtein M, Beloosesky R, Ginsberg Y, Weiner Z, Zmora O, Gover A. Early prenatal diagnosis of double inlet left ventricle. J Matern Fetal Neonatal Med 2021; 35:8345-8349. [PMID: 34538210 DOI: 10.1080/14767058.2021.1974385] [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: 10/20/2022]
Abstract
OBJECTIVE The aim of this study to describe the presentation of double inlet left ventricle (DILV) very early in prenatal life, to assess its prevalence and to portray the associated anomalies. METHODS This was a retrospective study which included all the women who attended our clinic for early fetal screening sonography, between 2006 and 2020. Most of the screening was done at 14-16 weeks of gestation (except one high risk pregnancy, which was performed at nine gestational weeks), and included an anatomic fetal scan and Doppler imaging. The diagnosis of DILV was done based on sonographic features of abnormal four-chamber view. Complete fetal echocardiography was carried out to rule out additional heart malformations. RESULTS Out of 26,805 early prenatal transvaginal ultrasound screening examinations, 14 cases of DILV were diagnosed. The gestational age range of our DILV diagnosis was 9-16 gestational weeks. All pregnancies were terminated as per parental request. In five fetuses, a chromosomal analysis was performed, one had trisomy 21, and the rest fetuses had a normal karyotype. In two fetuses, an autopsy was performed and the diagnosis of DILV was confirmed in both. CONCLUSIONS Very early prenatal detection of DILV is possible and may have an implication in parent decision regarding their pregnancy future.
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Affiliation(s)
- Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Moshe Bronshtein
- Faculty of Social Welfare and Health Sciences, University of Haifa Faculty of Social Welfare and Health Sciences, Haifa, Israel
| | - Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yuval Ginsberg
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Osnat Zmora
- Department of Pediatric Surgery, Shamir Medical Center, Zerifin, Israel
| | - Ayala Gover
- Neonatal Intensive Care Unit, Carmel Medical Center, Haifa, Israel
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12
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McCabe M, An N, Aboulhosn J, Schwarzenberger J, Canobbio M, Vallera C, Hong R. Anesthetic management for the peripartum care of women with Fontan physiology. Int J Obstet Anesth 2021; 48:103210. [PMID: 34425324 DOI: 10.1016/j.ijoa.2021.103210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 06/21/2021] [Accepted: 07/22/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND As outcomes for surgical palliation have improved, women with single ventricle congenital heart disease are surviving into their reproductive years and may become pregnant. The cardiovascular changes of pregnancy may stress the Fontan circulation and pose significant risk to the mother and fetus. METHODS Pregnant women with Fontan physiology were identified from the Ahmanson/UCLA Adult Congenital Heart Disease Center database. A total of 37 pregnancies were identified between 2000 and 2019. Twenty live births from 19 patients were reviewed and compared for cardiac history, obstetric history, anesthetic management and cardiovascular outcomes. RESULTS Median gestational age at delivery was 35 weeks. Ten of 20 births were by cesarean delivery. An epidural technique was used as the primary anesthetic for 19 deliveries and general anesthesia was used for one cesarean delivery. An arterial line was placed in the peripartum period for three deliveries. Central venous access was established in the peripartum period for one patient. The mean blood loss for cesarean deliveries was 626 mL (range 240-1200 mL). The mean net peri-operative intake/output was positive 93.5 mL. Three patients were briefly transferred to the intensive care unit postpartum for higher level monitoring and care. CONCLUSION Epidural anesthesia is safe and effective for both vaginal and cesarean deliveries. Judicious fluid management is critical in minimizing postpartum cardiovascular complications. Many patients do not require a higher level of care, invasive monitoring or central venous access during the peripartum period.
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Affiliation(s)
- M McCabe
- Loma Linda University, Department of Anesthesiology, Los Angeles, CA, USA
| | - N An
- UCLA, Department of Anesthesiology and Perioperative Medicine, CA, USA.
| | - J Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Disease Center, CA, USA
| | - J Schwarzenberger
- UCLA, Department of Anesthesiology and Perioperative Medicine, CA, USA
| | - M Canobbio
- Ahmanson/UCLA Adult Congenital Heart Disease Center, CA, USA
| | - C Vallera
- UCLA, Department of Anesthesiology and Perioperative Medicine, CA, USA
| | - R Hong
- UCLA, Department of Anesthesiology and Perioperative Medicine, CA, USA
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13
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Chung EH, Lim SL, Havrilesky LJ, Steiner AZ, Dotters-Katz SK. Cost-effectiveness of prenatal screening methods for congenital heart defects in pregnancies conceived by in-vitro fertilization. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:979-986. [PMID: 32304621 DOI: 10.1002/uog.22048] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/28/2020] [Accepted: 04/03/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To determine if a policy of universal fetal echocardiography (echo) in pregnancies conceived by in-vitro fertilization (IVF) is cost-effective as a screening strategy for congenital heart defects (CHDs) and to examine the cost-effectiveness of various other CHD screening strategies in IVF pregnancies. METHODS A decision-analysis model was designed from a societal perspective with respect to the obstetric patient, to compare the cost-effectiveness of three screening strategies: (1) anatomic ultrasound (US): selective fetal echo following abnormal cardiac findings on detailed anatomic survey; (2) intracytoplasmic sperm injection (ICSI) only: fetal echo for all pregnancies following IVF with ICSI; (3) all IVF: fetal echo for all IVF pregnancies. The model initiated at conception and had a time horizon of 1 year post-delivery. The sensitivities and specificities for each strategy, the probabilities of major and minor CHDs and all other clinical estimates were derived from the literature. Costs, including imaging, consults, surgeries and caregiver productivity losses, were derived from the literature and Medicare databases, and are expressed in USA dollars ($). Effectiveness was quantified as quality-adjusted life years (QALYs), based on how the strategies would affect the quality of life of the obstetric patient. Secondary effectiveness was quantified as number of cases of CHD and, specifically, cases of major CHD, detected. RESULTS The average base-case cost of each strategy was as follows: anatomic US, $8119; ICSI only, $8408; and all IVF, $8560. The effectiveness of each strategy was as follows: anatomic US, 1.74487 QALYs; ICSI only, 1.74497 QALYs; and all IVF, 1.74499 QALYs. The ICSI-only strategy had an incremental cost-effectiveness ratio (ICER) of $2 840 494 per additional QALY gained when compared to the anatomic-US strategy, and the all-IVF strategy had an ICER of $5 692 457 per additional QALY when compared with the ICSI-only strategy. Both ICERs exceeded considerably the standard willingness-to-pay threshold of $50 000-$100 000 per QALY. In a secondary analysis, the ICSI-only strategy had an ICER of $527 562 per additional case of major CHD detected when compared to the anatomic-US strategy. All IVF had an ICER of $790 510 per case of major CHD detected when compared with ICSI only. It was determined that it would cost society five times more to detect one additional major CHD through intensive screening of all IVF pregnancies than it would cost to pay for the neonate's first year of care. CONCLUSION The most cost-effective method of screening for CHDs in pregnancies following IVF, either with or without ICSI, is to perform a fetal echo only when abnormal cardiac findings are noted on the detailed anatomy scan. Performing routine fetal echo for all IVF pregnancies is not cost-effective. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E H Chung
- Duke University, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - S L Lim
- Duke University, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - L J Havrilesky
- Duke University, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - A Z Steiner
- Duke University, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - S K Dotters-Katz
- Duke University, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
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14
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Coney T, Russell R, Leuthner SR, Palatnik A. Maternal Outcomes of Ongoing Pregnancies Complicated by Fetal Life-Limiting Conditions. Am J Perinatol 2021; 38:99-104. [PMID: 32645723 DOI: 10.1055/s-0040-1713927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to examine maternal outcomes of ongoing pregnancies complicated by fetal life-limiting conditions. STUDY DESIGN This was a retrospective matched cohort study of women with a diagnosis of fetal life-limiting condition between 2010 and 2018 in a single academic center. Cases were matched to controls (women who had normal fetal anatomic survey) according to year of delivery, body mass index, and parity in a 1:4 ratio. Bivariable and multivariable analyses were performed to compare the prevalence of the primary composite outcome, which included any one of the following: preeclampsia, gestational diabetes, cesarean delivery, third and fourth degree laceration, postpartum hemorrhage, blood transfusion, endometritis or wound infection, maternal intensive care unit admission, hysterectomy and maternal death, between cases and controls. RESULTS During the study period, we found 101 cases that met inclusion criteria, matched to 404 controls. The rate of the composite maternal outcome did not differ between the two groups (39.6 vs. 38.9%, p = 0.948). For individual outcomes, women with diagnosis of fetal life-limiting condition had higher rates of blood transfusion (2.0 vs. 0%, p = 0.005) and longer length of the first stage of labor (median of 12 [6.8-22.0] hours vs. 6.6 [3.9-11.0] hours; p < 0.001). In a multivariable analysis, first stage of labor continued to be longer by an average of 6.48 hours among women with a diagnosis of fetal life-limiting condition compared with controls. CONCLUSION After controlling for confounding factors, except a longer first stage of labor, women diagnosed with fetal life-limiting conditions who continued the pregnancy did not have a higher rate of adverse maternal outcomes. KEY POINTS · The rates of ongoing pregnancies with fetal life-limiting conditions are increasing.. · Women with ongoing pregnancies with fetal life-limiting conditions had longer first stage of labor.. · The rest of the adverse maternal outcomes were not increased in this obstetric population..
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Affiliation(s)
- Talia Coney
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rachel Russell
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Steven R Leuthner
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anna Palatnik
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
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15
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Pregnancy and early post-natal outcomes of fetuses with functionally univentricular heart in a low-and-middle-income country. Cardiol Young 2020; 30:1844-1850. [PMID: 32959750 DOI: 10.1017/s1047951120002929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Care of children with functionally univentricular hearts is resource-intensive. OBJECTIVES To analyse pregnancy and early post-natal outcomes of fetuses with functionally univentricular hearts in the setting of a low-middle-income country. METHODS A retrospective study was conducted during the period of January 2008-October 2019. Study variables analysed included gestational age at diagnosis, maternal and fetal comorbidities and cardiac diagnosis including morphologic type of single ventricle. Outcomes analysed included pregnancy outcomes, type of post-natal care and survival status on the last follow-up. RESULTS A total of 504 fetuses were included. Mean maternal age was 27.5 ± 4.8 years and mean gestational age at diagnosis was 25.6 ± 5.7 weeks. Pregnancy outcomes included non-continued pregnancies (54%), live births (42.7%) and loss to follow-up (3.3%). Gestational age at diagnosis was the only factor that impacted pregnancy outcomes (non-continued pregnancies 22.5 ± 3.5 vs. live births 29.7 ± 5.7 weeks; p < 0.001). Of the 215 live births, intention-to-treat was reported in 119 (55.3%) cases; of these 103 (86.6%) underwent cardiac procedures. Seventy-nine patients (36.7%) opted for comfort care. On follow-up (median 10 (1-120) months), 106 patients (21%) were alive. Parental choice of intention-to-.treat or comfort care was the only factor that impacted survival on follow-up. CONCLUSIONS Prenatal diagnosis of functionally univentricular hearts was associated with overall low survival status on follow-up due to parental decisions on not to continue pregnancy or non-intention-to-treat after birth. Early detection of these complex defects by improved prenatal screening can enhance parental options and reduce resource impact in low-and-middle-income countries.
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16
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Alphonso N, Angelini A, Barron DJ, Bellsham-Revell H, Blom NA, Brown K, Davis D, Duncan D, Fedrigo M, Galletti L, Hehir D, Herberg U, Jacobs JP, Januszewska K, Karl TR, Malec E, Maruszewski B, Montgomerie J, Pizzaro C, Schranz D, Shillingford AJ, Simpson JM. Guidelines for the management of neonates and infants with hypoplastic left heart syndrome: The European Association for Cardio-Thoracic Surgery (EACTS) and the Association for European Paediatric and Congenital Cardiology (AEPC) Hypoplastic Left Heart Syndrome Guidelines Task Force. Eur J Cardiothorac Surg 2020; 58:416-499. [DOI: 10.1093/ejcts/ezaa188] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Nelson Alphonso
- Queensland Pediatric Cardiac Service, Queensland Children’s Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Annalisa Angelini
- Department of Cardiac, Thoracic Vascular Sciences and Public health, University of Padua Medical School, Padua, Italy
| | - David J Barron
- Department of Cardiovascular Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Nico A Blom
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Katherine Brown
- Paediatric Intensive Care, Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Deborah Davis
- Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA, USA
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
| | - Daniel Duncan
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
| | - Marny Fedrigo
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Lorenzo Galletti
- Unit of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - David Hehir
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ulrike Herberg
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | | | - Katarzyna Januszewska
- Division of Pediatric Cardiac Surgery, University Hospital Muenster, Westphalian-Wilhelm’s-University, Muenster, Germany
| | | | - Edward Malec
- Division of Pediatric Cardiac Surgery, University Hospital Muenster, Westphalian-Wilhelm’s-University, Muenster, Germany
| | - Bohdan Maruszewski
- Department for Pediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - James Montgomerie
- Department of Anesthesia, Birmingham Children’s Hospital, Birmingham, UK
| | - Christian Pizzaro
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dietmar Schranz
- Pediatric Heart Center, Justus-Liebig University, Giessen, Germany
| | - Amanda J Shillingford
- Division of Cardiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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17
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Pickard SS, Wong JB, Bucholz EM, Newburger JW, Tworetzky W, Lafranchi T, Benson CB, Wilkins-Haug LE, Porras D, Callahan R, Friedman KG. Fetal Aortic Valvuloplasty for Evolving Hypoplastic Left Heart Syndrome: A Decision Analysis. Circ Cardiovasc Qual Outcomes 2020; 13:e006127. [PMID: 32252549 DOI: 10.1161/circoutcomes.119.006127] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Fetal aortic valvuloplasty (FAV) may prevent progression of midgestation aortic stenosis to hypoplastic left heart syndrome. However, FAV has well-established risks, and its survival benefit remains unknown. Our primary aim was to determine whether FAV for midgestation aortic stenosis increases survival from fetal diagnosis to age 6 years. METHODS AND RESULTS We performed a retrospective analysis of 143 fetuses who underwent FAV from 2000 to 2017 and a secondary analysis of the Pediatric Heart Network Single Ventricle Reconstruction trial. Using these results, we developed a decision model to estimate probability of transplant-free survival from fetal diagnosis to age 6 years and postnatal restricted mean transplant-free survival time. FAV was technically successful in 84% of 143 fetuses with fetal demise in 8%. Biventricular circulation was achieved in 50% of 111 live-born infants with successful FAV but in only 16% of the 19 patients with unsuccessful FAV. The model projected overlapping probabilities of transplant-free survival to age 6 years at 75% (95% CI, 67%-82%) with FAV versus 72% (95% CI, 61%-82%) with expectant fetal management, resulting in a restricted mean transplant-free survival time benefit of 1.2 months. When limiting analyses to the improved FAV experience since 2009 to reflect current practice, (probability of technical success [94%], fetal demise [4%], and biventricular circulation [66%]), the model projected that FAV increased the probability of survival to age 6 years to 82% (95% CI, 73%-89%). Expectant management is favored if risk of fetal demise exceeded 12% or probability of biventricular circulation fell below 26%, but FAV remained favored over plausible recent range of technical success. CONCLUSIONS Our model suggests that FAV provides a modest, medium-term survival benefit over expectant fetal management. Appropriate patient selection and low risk of fetal demise with FAV are critical factors for obtaining a survival benefit.
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Affiliation(s)
- Sarah S Pickard
- Department of Cardiology, Boston Children's Hospital, MA (S.S.P., E.M.B., J.W.N., W.T., T.L., D.P., R.C., K.G.F.).,Departments of Pediatrics (S.S.P., E.B., J.W.N., W.T., D.P., R.C., K.G.F.), Harvard Medical School, Boston, MA
| | - John B Wong
- Division of Clinical Decision Making, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA (J.B.W.)
| | - Emily M Bucholz
- Department of Cardiology, Boston Children's Hospital, MA (S.S.P., E.M.B., J.W.N., W.T., T.L., D.P., R.C., K.G.F.).,Departments of Pediatrics (S.S.P., E.B., J.W.N., W.T., D.P., R.C., K.G.F.), Harvard Medical School, Boston, MA
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, MA (S.S.P., E.M.B., J.W.N., W.T., T.L., D.P., R.C., K.G.F.).,Departments of Pediatrics (S.S.P., E.B., J.W.N., W.T., D.P., R.C., K.G.F.), Harvard Medical School, Boston, MA
| | - Wayne Tworetzky
- Department of Cardiology, Boston Children's Hospital, MA (S.S.P., E.M.B., J.W.N., W.T., T.L., D.P., R.C., K.G.F.).,Departments of Pediatrics (S.S.P., E.B., J.W.N., W.T., D.P., R.C., K.G.F.), Harvard Medical School, Boston, MA
| | - Terra Lafranchi
- Department of Cardiology, Boston Children's Hospital, MA (S.S.P., E.M.B., J.W.N., W.T., T.L., D.P., R.C., K.G.F.)
| | - Carol B Benson
- Departments of Radiology (C.B.B.), Brigham and Women's Hospital, Boston, MA
| | - Louise E Wilkins-Haug
- Obstetrics and Gynecology (L.E.W.-H.), Brigham and Women's Hospital, Boston, MA.,Obstetrics and Gynecology, (L.E.W.-H.), Harvard Medical School, Boston, MA
| | - Diego Porras
- Department of Cardiology, Boston Children's Hospital, MA (S.S.P., E.M.B., J.W.N., W.T., T.L., D.P., R.C., K.G.F.).,Departments of Pediatrics (S.S.P., E.B., J.W.N., W.T., D.P., R.C., K.G.F.), Harvard Medical School, Boston, MA
| | - Ryan Callahan
- Department of Cardiology, Boston Children's Hospital, MA (S.S.P., E.M.B., J.W.N., W.T., T.L., D.P., R.C., K.G.F.).,Departments of Pediatrics (S.S.P., E.B., J.W.N., W.T., D.P., R.C., K.G.F.), Harvard Medical School, Boston, MA
| | - Kevin G Friedman
- Department of Cardiology, Boston Children's Hospital, MA (S.S.P., E.M.B., J.W.N., W.T., T.L., D.P., R.C., K.G.F.).,Departments of Pediatrics (S.S.P., E.B., J.W.N., W.T., D.P., R.C., K.G.F.), Harvard Medical School, Boston, MA
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18
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Marín Rodríguez C, Álvarez Martín T, Lancharro Zapata Á, Ruiz Martín Y, Sánchez Alegre M, Delgado Carrasco J. Evolution and trends in a pediatric cardiac magnetic resonance imaging program in a tertiary hospital over a 14-year period. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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19
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Evolución y tendencias de un programa de resonancia magnética cardiaca pediátrica en un hospital terciario durante 14 años. RADIOLOGIA 2019; 61:489-497. [DOI: 10.1016/j.rx.2019.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/18/2019] [Accepted: 05/03/2019] [Indexed: 11/17/2022]
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20
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Haxel C, Glickstein J, Parravicini E. Neonatal Palliative Care for Complicated Cardiac Anomalies: A 10-Year Experience of an Interdisciplinary Program at a Large Tertiary Cardiac Center. J Pediatr 2019; 214:79-88. [PMID: 31655705 DOI: 10.1016/j.jpeds.2019.07.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/18/2019] [Accepted: 07/18/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To report the outcomes of a Neonatal Palliative Care (NPC) Program at a large tertiary cardiac center caring for a subset of fetuses and neonates with life-limiting cardiac diagnoses or cardiac diagnoses with medical comorbidities leading to adverse prognoses. STUDY DESIGN The Neonatal Comfort Care Program at New York-Presbyterian Morgan Stanley Children's Hospital/Columbia University Medical Center is an interdisciplinary team that offers the option of NPC to neonates prenatally diagnosed with life-limiting conditions, including single ventricle (SV) congenital heart disease (CHD) or less severe forms of CHD complicated by multiorgan dysfunction or genetic syndromes. RESULTS From 2008 to 2017, the Neonatal Comfort Care Program cared for 75 fetuses or neonates including 29 with isolated SV CHD, 36 with CHD and multiorgan dysfunction and/or severe genetic abnormalities, and 10 neonates with a prenatal diagnosis of isolated CHD and postnatal diagnoses of severe conditions who were initially in intensive care before transitioning to NPC because of a poor prognosis. CONCLUSIONS At New York-Presbyterian Morgan Stanley Children's Hospital/Columbia University Medical Center, a large tertiary cardiac center, 13.5% of parents of fetuses or neonates with isolated SV CHD opted for NPC. Twenty-six of 29 newborns with SV CHD treated with NPC died. Of the remaining, 2 neonates with mixing lesions are alive at 3 and 5 years of age, and 1 neonate was initially treated with NPC and then pursued surgical palliation. These results suggest that NPC is a reasonable choice for neonates with SV CHD.
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Affiliation(s)
- Caitlin Haxel
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Denver School of Medicine, Aurora, CO; Division of Pediatric Cardiology, Department of Pediatrics, NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY.
| | - Julie Glickstein
- Division of Pediatric Cardiology, Department of Pediatrics, NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY
| | - Elvira Parravicini
- Division of Pediatric Cardiology, Department of Pediatrics, NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY
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21
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Yang L, He X, Lu Y, Huang F, Shi G, Chen H, Zheng J, Zhu Z, Chen P. Integrated model for the prenatal diagnosis and postnatal surgical treatment of total anomalous pulmonary venous connection: A multidisciplinary collaborative experience and preliminary results. J Card Surg 2019; 34:1264-1272. [PMID: 31475761 DOI: 10.1111/jocs.14242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND This study aimed to evaluate an integrated model for the prenatal diagnosis and postnatal treatment of total anomalous pulmonary venous connection (TAPVC). METHODS From January 2014 to December 2018, 11 patients were considered as a prenatally diagnosed group, who would accept the integrated model for prenatal diagnosis and postnatal treatment of TAPVC. Besides, 25 patients as postnatally diagnosed group underwent emergency surgery during the corresponding period at the same age. The perioperative status, survival and risk factors for death were compared between the two groups. RESULTS In a prenatally diagnosed group, three pregnant women chose termination; eight patients followed the integrated model, and their newborns were rapidly transported to a children's hospital within 24 hours after birth. Other than one patient who was prenatally diagnosed with infracardiac type was later confirmed as a mixed type of TAPVC, the prenatal and postnatal diagnoses of the other seven patients were consistent. The 30-day, 1-year, and 5-year survival rates in the prenatally diagnosed group were 100%, 100%, and 100%, while those in the postnatally diagnosed group were 92%, 87.8%, and 87.8%, without significant difference (P > .05). Although Fisher's exact test indicated that an oxygen saturation <70% at admission might be an independent predictor of mortality (P < .01), none of the risk factors for death were significantly different by multivariate Cox regression analysis. CONCLUSION The integrated model of prenatal diagnosis and postnatal treatment by multidisciplinary collaboration could lead to satisfactory outcomes, and prenatal diagnosis combined with postnatal oxygen saturation evaluation would facilitate early intervention for TAPVC.
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Affiliation(s)
- Lijuan Yang
- Department of Ultrasound, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaomin He
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Lu
- Department of Ultrasound, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fan Huang
- Department of Ultrasound, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guocheng Shi
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huiwen Chen
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinghao Zheng
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhongqun Zhu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Chen
- Department of Ultrasound, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
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22
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Advanced care planning in adult congenital heart disease: Transitioning from repair to palliation and end-of-life care. Int J Cardiol 2019; 279:57-61. [DOI: 10.1016/j.ijcard.2018.10.078] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/07/2018] [Accepted: 10/24/2018] [Indexed: 11/19/2022]
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23
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Weber RW, Stiasny B, Ruecker B, Fasnacht M, Cavigelli-Brunner A, Valsangiacomo Buechel ER. Prenatal Diagnosis of Single Ventricle Physiology Impacts on Cardiac Morbidity and Mortality. Pediatr Cardiol 2019; 40:61-70. [PMID: 30121866 DOI: 10.1007/s00246-018-1961-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/10/2018] [Indexed: 10/28/2022]
Abstract
We sought to evaluate the impact of prenatal diagnosis on morbidity and mortality in single ventricle (SV) lesions. All consecutive patients with pre- or postnatally diagnosed SV physiology admitted to our centre between January 2001 and June 2013 were reviewed. Primary endpoints included survival until 30 days after bidirectional cavopulmonary connection (BCPC) without transplant or BCPC takedown. Prenatal diagnosis was performed in 160 of 259 cases (62%). After excluding all cases with termination of pregnancy, intrauterine demise or treated with comfort care, a total of 180 neonates were admitted to our centre for treatment, including 87 with a prenatal and 93 with a postnatal diagnosis. Both groups showed similar distribution regarding diagnosis, dominant ventricle and risk factors such as restrictive foramen or some form of atrial isomerism. A larger proportion of postnatally diagnosed children presented at admission with elevated lactate > 10 mmol/l (p = 0.02), a higher dose of prostaglandin (p = 0.0013) and need for mechanical ventilation (p < 0.0001). Critical lesions such as hypoplastic left heart syndrome were an important determinant for morbidity and mortality. Thirty-days survival after BCPC was better in patients with prenatal diagnosis (p = 0.025). Prenatal diagnosis is associated with higher survival in neonates with SV physiology.
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Affiliation(s)
- Roland W Weber
- Pediatric Heart Centre, University Children's Hospital, Steinwiesstrasse 75, 8032, Zurich, Switzerland. .,Children's Research Centre, Zurich, Switzerland.
| | - Brian Stiasny
- Pediatric Heart Centre, University Children's Hospital, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Centre, Zurich, Switzerland
| | - Beate Ruecker
- Pediatric Heart Centre, University Children's Hospital, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Centre, Zurich, Switzerland
| | | | - Anna Cavigelli-Brunner
- Pediatric Heart Centre, University Children's Hospital, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Centre, Zurich, Switzerland
| | - Emanuela R Valsangiacomo Buechel
- Pediatric Heart Centre, University Children's Hospital, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Children's Research Centre, Zurich, Switzerland
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24
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Abstract
The care of children with hypoplastic left heart syndrome is constantly evolving. Prenatal diagnosis of hypoplastic left heart syndrome will aid in counselling of parents, and selected fetuses may be candidates for in utero intervention. Following birth, palliation can be undertaken through staged operations: Norwood (or hybrid) in the 1st week of life, superior cavopulmonary connection at 4-6 months of life, and finally total cavopulmonary connection (Fontan) at 2-4 years of age. Children with hypoplastic left heart syndrome are at risk of circulatory failure their entire life, and selected patients may undergo heart transplantation. In this review article, we summarise recent advances in the critical care management of patients with hypoplastic left heart syndrome as were discussed in a focused session at the 12th International Conference of the Paediatric Cardiac Intensive Care Society held on 9 December, 2016, in Miami Beach, Florida.
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25
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Liu MY, Zielonka B, Snarr BS, Zhang X, Gaynor JW, Rychik J. Longitudinal Assessment of Outcome From Prenatal Diagnosis Through Fontan Operation for Over 500 Fetuses With Single Ventricle-Type Congenital Heart Disease: The Philadelphia Fetus-to-Fontan Cohort Study. J Am Heart Assoc 2018; 7:e009145. [PMID: 30371305 PMCID: PMC6404885 DOI: 10.1161/jaha.118.009145] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/27/2018] [Indexed: 11/24/2022]
Abstract
Background Prenatal diagnosis of single ventricle-type congenital heart disease is associated with improved clinical courses. Prenatal counseling allows for optimal delivery preparations and opportunity for prenatal intervention. Expectant parents frequently ask what the likelihood of survival through staged palliation is and the factors that influence outcome. Our goal was specifically to quantify peri- and postnatal outcomes in this population. Methods and Results We identified all patients with a prenatal diagnosis of single ventricle-type congenital heart disease presenting between July 2004 and December 2011 at our institution. Maternal data, fetal characteristics, and data from the postnatal clinical course were collected for each patient. Kaplan-Meier curves and multivariate analysis with logistic regression were used to evaluate variables associated with decreased transplant-free survival. Five hundred two patients were identified, consisting of 381 (76%) right ventricle- and 121 left ventricle-dominant lesions. After prenatal diagnosis, 42 patients did not follow up at our center; 79 (16%) chose termination of pregnancy, and 11 had intrauterine demise with 370 (74%) surviving to birth. Twenty-two (6%) underwent palliative care at birth. Among 348 surviving to birth with intention to treat, 234 (67%) survived to at least 6 months post-Fontan palliation. Presence of fetal hydrops, right ventricle dominance, presence of extracardiac anomalies, and low birthweight were significantly associated with decreased transplant-free survival. Conclusions In patients with a prenatal diagnosis of single ventricle-type congenital heart disease and intention to treat, 67% survive transplant-free to at least 6 months beyond Fontan operation. An additional 5% survive to 4 years of age without transplant or Fontan completion. Fetuses with right ventricle-dominant lesions, extracardiac anomalies, hydrops, or low birthweights have decreased transplant-free survival.
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Affiliation(s)
- Michael Y. Liu
- Divisions of Cardiology and Cardiothoracic SurgeryThe Children's Hospital of Philadelphia, PhiladelphiaPA
- Departments of Pediatrics and SurgeryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
| | - Benjamin Zielonka
- Divisions of Cardiology and Cardiothoracic SurgeryThe Children's Hospital of Philadelphia, PhiladelphiaPA
- Departments of Pediatrics and SurgeryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
| | - Brian S. Snarr
- Divisions of Cardiology and Cardiothoracic SurgeryThe Children's Hospital of Philadelphia, PhiladelphiaPA
- Departments of Pediatrics and SurgeryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
| | - Xuemei Zhang
- Divisions of Cardiology and Cardiothoracic SurgeryThe Children's Hospital of Philadelphia, PhiladelphiaPA
- Departments of Pediatrics and SurgeryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
| | - J. William Gaynor
- Divisions of Cardiology and Cardiothoracic SurgeryThe Children's Hospital of Philadelphia, PhiladelphiaPA
- Departments of Pediatrics and SurgeryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
| | - Jack Rychik
- Divisions of Cardiology and Cardiothoracic SurgeryThe Children's Hospital of Philadelphia, PhiladelphiaPA
- Departments of Pediatrics and SurgeryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA
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26
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Wolter A, Nosbüsch S, Kawecki A, Degenhardt J, Enzensberger C, Graupner O, Vorisek C, Akintürk H, Yerebakan C, Khalil M, Schranz D, Ritgen J, Stressig R, Axt-Fliedner R. Prenatal diagnosis of functionally univentricular heart, associations and perinatal outcomes. Prenat Diagn 2016; 36:545-54. [DOI: 10.1002/pd.4821] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 04/01/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Aline Wolter
- University Hospital UKGM, Justus-Liebig University; Department of OB/GYN, Division of Prenatal Medicine; Giessen Germany
| | - Sina Nosbüsch
- University Hospital UKGM, Justus-Liebig University; Department of OB/GYN, Division of Prenatal Medicine; Giessen Germany
| | - Andreea Kawecki
- University Hospital UKGM, Justus-Liebig University; Department of OB/GYN, Division of Prenatal Medicine; Giessen Germany
| | - Jan Degenhardt
- University Hospital UKGM, Justus-Liebig University; Department of OB/GYN, Division of Prenatal Medicine; Giessen Germany
| | - Christian Enzensberger
- University Hospital UKGM, Phillips University; Department of OB/GYN, Division of Prenatal Medicine; Marburg Germany
| | - Oliver Graupner
- University Hospital, Klinikum rechts der Isar; Technische Universität, Department of OB/GYN; München Germany
| | - Carina Vorisek
- University Hospital UKGM, Justus-Liebig University; Department of OB/GYN, Division of Prenatal Medicine; Giessen Germany
| | - Hakan Akintürk
- Pediatric Heart Center, University Hospital, Justus-Liebig University; Division of Pediatric Heart Surgery; Giessen Germany
| | - Can Yerebakan
- Pediatric Heart Center, University Hospital, Justus-Liebig University; Division of Pediatric Heart Surgery; Giessen Germany
| | - Markus Khalil
- Pediatric Heart Center, University Hospital, Justus-Liebig University; Division of Pediatric Cardiology; Giessen Germany
| | - Dietmar Schranz
- Pediatric Heart Center, University Hospital, Justus-Liebig University; Division of Pediatric Cardiology; Giessen Germany
| | - Jochen Ritgen
- praenatal.de, Prenatal Medicine and Genetics; Köln Germany
| | | | - Roland Axt-Fliedner
- University Hospital UKGM, Justus-Liebig University; Department of OB/GYN, Division of Prenatal Medicine; Giessen Germany
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27
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Lee SM, Kwon JE, Song SH, Kim GB, Park JY, Kim BJ, Lee JH, Park CW, Park JS, Jun JK. Prenatal prediction of neonatal death in single ventricle congenital heart disease. Prenat Diagn 2016; 36:346-52. [DOI: 10.1002/pd.4787] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 01/04/2016] [Accepted: 01/30/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Seung Mi Lee
- Department of Obstetrics and Gynecology; Seoul National University College of Medicine; Seoul Korea
- Department of Obstetrics and Gynecology; Seoul Metropolitan Government Seoul National University Boramae Medical Center; Seoul Korea
| | - Jeong Eun Kwon
- Department of Obstetrics and Gynecology; Seoul National University College of Medicine; Seoul Korea
| | - Sang Hoon Song
- Department of Laboratory Medicine; Seoul National University College of Medicine; Seoul Korea
| | - Gi. Beom Kim
- Department of Pediatrics; Seoul National University College of Medicine; Seoul Korea
| | - Jung Yeon Park
- Department of Obstetrics and Gynecology; Seoul National University College of Medicine; Seoul Korea
| | - Byoung Jae Kim
- Department of Obstetrics and Gynecology; Seoul National University College of Medicine; Seoul Korea
- Department of Obstetrics and Gynecology; Seoul Metropolitan Government Seoul National University Boramae Medical Center; Seoul Korea
| | - Joon Ho Lee
- Department of Obstetrics and Gynecology; Seoul National University College of Medicine; Seoul Korea
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology; Seoul National University College of Medicine; Seoul Korea
| | - Joong Shin Park
- Department of Obstetrics and Gynecology; Seoul National University College of Medicine; Seoul Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology; Seoul National University College of Medicine; Seoul Korea
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28
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Chaix MA, Andelfinger G, Khairy P. Genetic testing in congenital heart disease: A clinical approach. World J Cardiol 2016; 8:180-191. [PMID: 26981213 PMCID: PMC4766268 DOI: 10.4330/wjc.v8.i2.180] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 10/16/2015] [Accepted: 12/11/2015] [Indexed: 02/06/2023] Open
Abstract
Congenital heart disease (CHD) is the most common type of birth defect. Traditionally, a polygenic model defined by the interaction of multiple genes and environmental factors was hypothesized to account for different forms of CHD. It is now understood that the contribution of genetics to CHD extends beyond a single unified paradigm. For example, monogenic models and chromosomal abnormalities have been associated with various syndromic and non-syndromic forms of CHD. In such instances, genetic investigation and testing may potentially play an important role in clinical care. A family tree with a detailed phenotypic description serves as the initial screening tool to identify potentially inherited defects and to guide further genetic investigation. The selection of a genetic test is contingent upon the particular diagnostic hypothesis generated by clinical examination. Genetic investigation in CHD may carry the potential to improve prognosis by yielding valuable information with regards to personalized medical care, confidence in the clinical diagnosis, and/or targeted patient follow-up. Moreover, genetic assessment may serve as a tool to predict recurrence risk, define the pattern of inheritance within a family, and evaluate the need for further family screening. In some circumstances, prenatal or preimplantation genetic screening could identify fetuses or embryos at high risk for CHD. Although genetics may appear to constitute a highly specialized sector of cardiology, basic knowledge regarding inheritance patterns, recurrence risks, and available screening and diagnostic tools, including their strengths and limitations, could assist the treating physician in providing sound counsel.
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29
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Brown DW, Mangeot C, Anderson JB, Peterson LE, King EC, Lihn SL, Neish SR, Fleishman C, Phelps C, Hanke S, Beekman RH, Lannon CM. Digoxin Use Is Associated With Reduced Interstage Mortality in Patients With No History of Arrhythmia After Stage I Palliation for Single Ventricle Heart Disease. J Am Heart Assoc 2016; 5:JAHA.115.002376. [PMID: 26755552 PMCID: PMC4859359 DOI: 10.1161/jaha.115.002376] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Interstage mortality (IM) remains significant after stage 1 palliation (S1P) for single‐ventricle heart disease (SVD), with many deaths sudden and unexpected. We sought to determine whether digoxin use post‐S1P is associated with reduced IM, utilizing the multicenter database of the National Pediatric Cardiology Quality Improvement Collaborative (NPCQIC). Methods and Results From June 2008 to July 2013, 816 infants discharged after S1P from 50 surgical sites completed the interstage to stage II palliation, transplant, or IM. Arrhythmia during S1P hospitalization or discharge on antiarrhythmic medications were exclusions (n=270); 2 patients were lost to follow‐up. Two analyses were performed: (1) propensity‐score adjusted logistic regression with IM as outcome and (2) retrospective cohort analysis for patients discharged on digoxin versus not, matched for surgical site and other established IM risk factors. Of 544 study patients, 119 (21.9%) were discharged on digoxin. Logistic regression analysis with propensity score, site‐size group, and digoxin use as predictor variables showed an increased risk of IM in those not discharged on digoxin (odds ratio, 8.6; lower confidence limit, 1.9; upper confidence limit, 38.3; P<0.01). The retrospective cohort analysis for 60 patients on digoxin (matched for site of care, type of S1P, post‐S1P ECMO use, genetic syndrome, discharge feeding route, ventricular function, tricuspid regurgitation, and aortic arch gradient) showed 0% IM in the digoxin at discharge group and an estimated IM difference between the 2 groups of 9% (P=0.04). Conclusions Among SVD infants in the NPCQIC database discharged post‐S1P with no history of arrhythmia, use of digoxin at discharge was associated with reduced IM.
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Affiliation(s)
- David W Brown
- Department of Cardiology, Boston Children's Hospital, Boston, MA (D.W.B.)
| | - Colleen Mangeot
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH (C.M., J.B.A., E.C.K., S.H., R.H.B., C.M.L.)
| | - Jeffrey B Anderson
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH (C.M., J.B.A., E.C.K., S.H., R.H.B., C.M.L.)
| | | | - Eileen C King
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH (C.M., J.B.A., E.C.K., S.H., R.H.B., C.M.L.)
| | | | - Steven R Neish
- University of Texas Health Science Center, San Antonio, TX (S.R.N.)
| | | | | | - Samuel Hanke
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH (C.M., J.B.A., E.C.K., S.H., R.H.B., C.M.L.)
| | - Robert H Beekman
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH (C.M., J.B.A., E.C.K., S.H., R.H.B., C.M.L.)
| | - Carole M Lannon
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH (C.M., J.B.A., E.C.K., S.H., R.H.B., C.M.L.)
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30
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Lafranchi T, Lincoln P. Prenatal Counseling and Care for Single-Ventricle Heart Disease: One Center’s Model for Care. Crit Care Nurse 2015; 35:53-61. [DOI: 10.4037/ccn2015247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Advances in prenatal imaging allow early detection of single-ventricle congenital heart disease, which may enhance prenatal care and maximize care options and decision making. Boston Children’s Hospital’s Advanced Fetal Care Center and fetal cardiology program provide prenatal counseling and care for single-ventricle congenital heart disease. Key points for optimal prenatal counseling and education include explanation of the diagnosis, delivery, the first surgery, cardiac neurodevelopmental issues, feeding and growth issues, quality of life and long-term care, family stressors, and fetal cardiac intervention. Such counseling and education help families make the difficult decisions required in this situation.
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Affiliation(s)
- Terra Lafranchi
- Terra Lafranchi is a nurse practitioner in the Department of Cardiology at Boston Children’s Hospital. She is the fetal cardiology coordinator and also provides longitudinal pediatric cardiac care
| | - Patricia Lincoln
- Patricia Lincoln is a clinical nurse specialist in the cardiovascular intensive care unit at Boston Children’s Hospital
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