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Fortin O, Mulkey SB, Fraser JL. Advancing fetal diagnosis and prognostication using comprehensive prenatal phenotyping and genetic testing. Pediatr Res 2024:10.1038/s41390-024-03343-9. [PMID: 38937640 DOI: 10.1038/s41390-024-03343-9] [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] [Received: 04/08/2024] [Revised: 05/14/2024] [Accepted: 06/04/2024] [Indexed: 06/29/2024]
Abstract
Prenatal diagnoses of congenital malformations have increased significantly in recent years with use of high-resolution prenatal imaging. Despite more precise radiological diagnoses, discussions with expectant parents remain challenging because congenital malformations are associated with a wide spectrum of outcomes. Comprehensive prenatal genetic testing has become an essential tool that improves the accuracy of prognostication. Testing strategies include chromosomal microarray, exome sequencing, and genome sequencing. The diagnostic yield varies depending on the specific malformations, severity of the abnormalities, and multi-organ involvement. The utility of prenatal genetic diagnosis includes increased diagnostic clarity for clinicians and families, informed pregnancy decision-making, neonatal care planning, and reproductive planning. Turnaround time for results of comprehensive genetic testing remains a barrier, especially for parents that are decision-making, although this has improved over time. Uncertainty inherent to many genetic testing results is a challenge. Appropriate genetic counseling is essential for parents to understand the diagnosis and prognosis and to make informed decisions. Recent research has investigated the yield of exome or genome sequencing in structurally normal fetuses, both with non-invasive screening methods and invasive diagnostic testing; the prenatal diagnostic community must evaluate and analyze the significant ethical considerations associated with this practice prior to generalizing its use. IMPACT: Reviews available genetic testing options during the prenatal period in detail. Discusses the impact of prenatal genetic testing on care using case-based examples. Consolidates the current literature on the yield of genetic testing for prenatal diagnosis of congenital malformations.
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Affiliation(s)
- Olivier Fortin
- Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
| | - Sarah B Mulkey
- Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
- Department of Neurology and Rehabilitation Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Jamie L Fraser
- Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA.
- Rare Disease Institute, Children's National Hospital, Washington, DC, USA.
- Center for Genetic Medicine Research, Children's National Hospital, Washington, DC, USA.
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
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Wautlet CK, Kops SA, Silveira LJ, Young K, Behrendt NJ, Zaretsky MV, Cuneo BF, Galan HL. Maternal-fetal comorbidities and obstetrical outcomes of fetal single ventricle cardiac defects: 10 years' experience with a multidisciplinary management protocol at a single center. Prenat Diagn 2024; 44:783-795. [PMID: 38782600 DOI: 10.1002/pd.6591] [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: 02/01/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES To describe and compare maternal and fetal comorbidities and obstetrical outcomes in pregnancies with hypoplastic left and right heart (HLHS and HRH) single ventricle cardiac defects (SVCD) from a single center under a multidisciplinary protocol. METHOD A single center retrospective review of fetal SVCD from 2013 to 2022. Maternal-fetal comorbidities, delivery, and postnatal outcomes were compared between HLHS and HRH using descriptive statistics and univariate and multivariate analyses. RESULTS Of 181 SVCD pregnancies (131 HLHS; 50 HRH), 9% underwent termination, 4% elected comfort care, 5 died in utero and 147/152 liveborns survived to the first cardiac intervention. Cesarean delivery occurred in 57 cases (37%), planned in 36 and unplanned in 21. Comorbidities, which did not differ between HLHS and HRH, included fetal growth restriction (FGR, 17%), prematurity (14%), maternal hypertension (9%), maternal obesity (50%), fetal extracardiac anomalies and chromosome anomalies (12%, 13%). In multivariate analysis, only earlier gestational age at delivery and oligohydramnios predicted decreased odds of survival at one year. CONCLUSION Maternal-fetal comorbidities are common in both HLHS and HRH. Earlier gestational age at delivery and oligohydramnios predict lower postnatal survival. FGR, even with severe early onset, did not significantly impact short- or long-term neonatal survival in single ventricle conditions.
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Affiliation(s)
- Cynthie K Wautlet
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, and Colorado Fetal Care Center, Children's Hospital of Colorado, Aurora, Colorado, USA
| | - Samantha A Kops
- Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, and Colorado Fetal Care Center, Children's Hospital of Colorado, Aurora, Colorado, USA
| | - Lori J Silveira
- Department of Pediatrics, University of Colorado School of Medicine, and Colorado Fetal Care Center, Children's Hospital of Colorado, Aurora, Colorado, USA
| | - Krista Young
- Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, and Colorado Fetal Care Center, Children's Hospital of Colorado, Aurora, Colorado, USA
| | - Nicholas J Behrendt
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, and Colorado Fetal Care Center, Children's Hospital of Colorado, Aurora, Colorado, USA
| | - Michael V Zaretsky
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, and Colorado Fetal Care Center, Children's Hospital of Colorado, Aurora, Colorado, USA
| | - Bettina F Cuneo
- Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, and Colorado Fetal Care Center, Children's Hospital of Colorado, Aurora, Colorado, USA
- Department of Obstetrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Henry L Galan
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, and Colorado Fetal Care Center, Children's Hospital of Colorado, Aurora, Colorado, USA
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Wang Y, Wang L, Zang H, Wang J, Wu H, Zhao W. Comparison of Different Ultrasonic Screening Methods and Analysis of High Risk Factors for Fetal Cardiac Malformation in Second Trimester of Pregnancy. Pediatr Cardiol 2024:10.1007/s00246-024-03525-6. [PMID: 38809278 DOI: 10.1007/s00246-024-03525-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/13/2024] [Indexed: 05/30/2024]
Abstract
Current study aims to compare the application of two-dimensional (2D) color doppler ultrasound (CDU) and four-dimensional (4D) ultrasound spatiotemporal image correlation (STIC) in fetal congenital heart disease in the second trimester of pregnancy and to analyze the high risk factors of the disease. From August 2019 to July 2021, 135 second-trimester patients with highly suspected congenital heart malformations were selected who underwent prenatal screening at South Taihu Hospital Affiliated to Huzhou University. 2D-CDU, 4D STIC, and postnatal examination were completed in all patients. 2D-CDU, 4D STIC and 2D-CDU combined with 4D STIC were used to detect fetal cardiac malformations and classify cardiac malformations. The sensitivity, specificity, positive predictive value, negative predictive value and coincidence rate of 2D-CDU, 4D STIC and 2D-CDU combined with 4D STIC were compared. The results of 2D-CDU, 4D STIC and 2D-CDU combined with 4D STIC screening were analyzed for consistency using the results of postpartum diagnosis as the gold standard. Moreover, effects of maternal gestational factors on fetal cardiac malformations by univariate and multivariate analysis. 2D-CDU combined with 4D STIC showed significantly higher section display number than 2D-CDU or 4D STIC in the view of ductal arch, aortic arch, and aortic short-axis. A total of 45 cases of fetal congenital heart malformation were detected in 135 patients in the second trimester, 40, 38 or 42 cases were detected by 2D-CDU, 4D STIC or 2D-CDU combined with 4D STIC, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and coincidence rate of 2D-CDU combined with 4D ultrasound in congenital heart malformation screening were higher than those of 2D-CDU or 4D STIC. Kappa agreement analysis showed that the diagnostic results of 4D STIC and 2D-CDU combined with 4D ultrasound in fetuses with suspected congenital heart malformation were in excellent agreement (κ > 0.75), while 2D-CDU was in good agreement with postpartum diagnosis (κ < 0.75). Univariate and multivariate regression analysis revealed that maternal age ≥ 35, drinking during pregnancy, and history of adverse pregnancy and childbirth were all independent risk factors for fetal cardiac malformations, while folic acid supplementation was an independent protective factor for fetal cardiac malformations. 2D-CDU combined with 4D echocardiography may be superior to single 2D-CDU or 4D STIC in the screening of fetal congenital heart malformation in the second trimester. In order to reduce the incidence of fetal heart anomalies, we should strengthen the screening of pregnancy anomalies in high-risk pregnant women and control the risk factors.
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Affiliation(s)
- Yanming Wang
- Department of Ultrasonography, South Taihu Hospital Affiliated to Huzhou College, Huzhou, 313000, Zhejiang Province, People's Republic of China
| | - Longfei Wang
- Department of Anesthesiology, South Taihu Hospital Affiliated to Huzhou College , Huzhou, 313000, Zhejiang Province, People's Republic of China
| | - Haifeng Zang
- Department of Ultrasonography, South Taihu Hospital Affiliated to Huzhou College, Huzhou, 313000, Zhejiang Province, People's Republic of China
| | - Jie Wang
- The People's Hospital of Huaiyang District, Zhoukou, 466700, Henan Province, People's Republic of China
| | - Hao Wu
- Ultrasound Department, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang Province, People's Republic of China.
| | - Wei Zhao
- Ultrasound Department, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang Province, People's Republic of China.
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Kavanaugh-McHugh A, Zuckerwise LC, Killen SAS, Morris EA, Sullivan RT, Alrifai MW, Bichell DP, Smith-Parrish M, Freud L. Management of Ebstein Anomaly in the Current Era: The Story of One Fetus and the Collaboration of Many-A Case Report. J Cardiovasc Dev Dis 2024; 11:147. [PMID: 38786969 PMCID: PMC11122070 DOI: 10.3390/jcdd11050147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/05/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
Collaborative multicenter research has significantly increased our understanding of fetal Ebstein anomaly, delineating risk factors for adverse outcomes as well as predictors of postnatal management. These data are incorporated into prenatal care and therapeutic strategies and inform family counseling and delivery planning to optimize care. This report details the translation of findings from multicenter studies into multidisciplinary prenatal care for a fetus with Ebstein anomaly, supraventricular tachycardia, and a circular shunt, including transplacental therapy to control arrhythmias and achieve ductal constriction, informed and coordinated delivery room management, and planned univentricular surgical palliation.
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Affiliation(s)
- Ann Kavanaugh-McHugh
- Thomas. P. Graham Jr. Division of Pediatric Cardiology, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Lisa C Zuckerwise
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Stacy A S Killen
- Thomas. P. Graham Jr. Division of Pediatric Cardiology, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Emily A Morris
- Division of Neonatology, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Rachel T Sullivan
- Thomas. P. Graham Jr. Division of Pediatric Cardiology, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Mhd Wael Alrifai
- Division of Neonatology, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - David P Bichell
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Melissa Smith-Parrish
- Division of Critical Care Medicine, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Lindsay Freud
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
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5
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Słodki M. Differential diagnosis in disproportion in four-chamber view in fetus in late pregnancy-Challenging dilemma. Echocardiography 2024; 41:e15803. [PMID: 38549394 DOI: 10.1111/echo.15803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 04/02/2024] Open
Affiliation(s)
- Maciej Słodki
- Collegium Medicum, The Mazovian University in Płock, Płock, Poland
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Patel SR, Michelfelder E. Prenatal Diagnosis of Congenital Heart Disease: The Crucial Role of Perinatal and Delivery Planning. J Cardiovasc Dev Dis 2024; 11:108. [PMID: 38667726 PMCID: PMC11050606 DOI: 10.3390/jcdd11040108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 03/29/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
Although most congenital heart defects (CHDs) are asymptomatic at birth, certain CHD lesions are at significant risk of severe hemodynamic instability and death if emergent cardiac interventions are not performed in a timely fashion. Therefore, accurate identification of at-risk fetuses and appropriate delivery resource planning according to the degree of anticipated hemodynamic instability is crucial. Fetal echocardiography has increased prenatal CHD detection in recent years due to advancements in ultrasound techniques and improved obstetrical cardiac screening protocols, enabling the prediction of newborns' hemodynamic status. This assessment can guide multidisciplinary resource planning for postnatal care, including selection of delivery site, delivery room management, and transport to a cardiac center based on CHD risk severity. This review will discuss fetal cardiovascular physiology and the circulatory changes that occur at the time of and immediately following birth, outline fetal echocardiographic findings used to risk-stratify newborns with CHDs, and outline principles for neonatal resuscitation and initial transitional care in neonates with these complex CHD lesions.
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Affiliation(s)
- Sheetal R. Patel
- Ann & Robert H Lurie Children’s Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Erik Michelfelder
- Children’s Healthcare of Atlanta, Emory School of Medicine, Emory University, Atlanta, GA 30265, USA
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7
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Moray A, Mugaba PM, Joynt C, McBrien A, Eckersley LG, Phillipos E, Holinski P, Ryerson L, Coe JY, Chandra S, Wong B, Derbyshire M, Lefebvre M, Al Aklabi M, Hornberger LK. Predicting High-Risk Fetal Cardiac Disease Anticipated to Need Immediate Postnatal Stabilization and Intervention with Planned Pediatric Cardiac Operating Room Delivery. J Am Heart Assoc 2024; 13:e031184. [PMID: 38497437 PMCID: PMC11010008 DOI: 10.1161/jaha.123.031184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/24/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Distances between delivery and cardiac services can make the care of fetuses with cardiac disease at risk of acute cardiorespiratory instability at birth a challenge. In 2013 we implemented a fetal echocardiography-based algorithm targeting fetuses considered high risk for acute cardiorespiratory instability at ≤2 hours of birth for delivery in our pediatric cardiac operating room of our children's hospital, and, herein, examine our experience. METHODS AND RESULTS We reviewed maternal and postnatal medical records of all fetuses with cardiac disease encountered January 2013 to March 2022 considered high risk for acute cardiorespiratory instability. Secondary analysis was performed including all fetuses with diagnoses of d-transposition of the great arteries/intact ventricular septum (d-TGA/IVS) and hypoplastic left heart syndrome (HLHS) encountered over the study period. Forty fetuses were considered high risk for acute cardiorespiratory instability: 15 with d-TGA/IVS and 7 with HLHS with restrictive atrial septum, 4 with absent pulmonary valve syndrome, 3 with obstructed anomalous pulmonary veins, 2 with severe Ebstein anomaly, 2 with thoracic/intracardiac tumors, and 7 others. Pediatric cardiac operating room delivery occurred for 33 but not for 7 (5 with d-TGA/IVS, 2 with HLHS with restrictive atrial septum). For high-risk cases, fetal echocardiography had a positive predictive value of 50% for intervention/extracorporeal membrane oxygenation/death at ≤2 hours and 70% at ≤24 hours. Of "low-risk" cases, 6/46 with d-TGA/IVS and 0/45 with HLHS required intervention at ≤2 hours. Fetal echocardiography for predicting intervention/extracorporeal membrane oxygenation/death at ≤2 hours had a sensitivity of 67%, specificity 93%, and positive and negative predictive values of 80% and 87%, respectively, for d-TGA/IVS, and 100%, 95%, 71%, and 100% for HLHS, respectively. CONCLUSIONS Fetal echocardiography can predict the need for urgent intervention in a majority with d-TGA/IVS and HLHS and in half of the entire spectrum of high-risk cardiac disease.
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Affiliation(s)
- Amol Moray
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics University of Alberta, Stollery Children's Hospital Edmonton Alberta Canada
| | - Proscovia M Mugaba
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics University of Alberta, Stollery Children's Hospital Edmonton Alberta Canada
| | - Chloe Joynt
- Division of Neonatology, Department of Pediatrics University of Alberta, Stollery Children's Hospital Edmonton Alberta Canada
| | - Angela McBrien
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics University of Alberta, Stollery Children's Hospital Edmonton Alberta Canada
| | - Luke G Eckersley
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics University of Alberta, Stollery Children's Hospital Edmonton Alberta Canada
| | - Ernest Phillipos
- Division of Neonatology, Department of Pediatrics University of Alberta, Stollery Children's Hospital Edmonton Alberta Canada
| | - Paula Holinski
- Division of Critical Care, Department of Pediatrics University of Alberta, Stollery Children's Hospital Edmonton Alberta Canada
- Department of Anesthesia University of Alberta, Stollery Children's Hospital Edmonton Alberta Canada
| | - Lindsay Ryerson
- Division of Critical Care, Department of Pediatrics University of Alberta, Stollery Children's Hospital Edmonton Alberta Canada
| | - James Yashu Coe
- Interventional Cardiology, Division of Cardiology, Department of Pediatrics University of Alberta, Stollery Children's Hospital Edmonton Alberta Canada
| | - Sujata Chandra
- Department of Obstetrics & Gynecology University of Alberta Edmonton Alberta Canada
| | - Billy Wong
- Department of Obstetrics & Gynecology University of Alberta Edmonton Alberta Canada
| | - Michele Derbyshire
- Stollery Pediatric and Mazankowski Adult Cardiac Operating Rooms, Alberta Health Services Edmonton Alberta Canada
| | - Maria Lefebvre
- Alberta Health Services and Stollery Children's Hospital Edmonton Alberta Canada
| | - Mohammed Al Aklabi
- Division of Pediatric Cardiovascular Surgery, Department of Surgery University of Alberta, Stollery Children's Hospital Edmonton Alberta Canada
| | - Lisa K Hornberger
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics University of Alberta, Stollery Children's Hospital Edmonton Alberta Canada
- Department of Obstetrics & Gynecology University of Alberta Edmonton Alberta Canada
- Women & Children's Health Research Institute & Cardiovascular Research Institute, University of Alberta, Stollery Children's Hospital Edmonton Alberta Canada
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8
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Dischinger AN, Li JS, Mulder H, Spears T, Chiswell KE, Hoffman TM, Hartman RJ, Walsh MJ, Sang CJ, Sarno LA, Paolillo JA, Welke K, D'Ottavio A, Sethi NJ. Impact of Prenatal Diagnosis of Critical Congenital Heart Disease on Preoperative and Postoperative Outcomes. Pediatr Cardiol 2023; 44:1520-1528. [PMID: 37289278 DOI: 10.1007/s00246-023-03197-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023]
Abstract
The objective of this study was to assess the relationship of prenatal diagnosis of critical congenital heart disease (CHD) to preoperative and postoperative patient findings. Retrospective analysis of neonates with critical CHD who underwent cardiothoracic surgery at one of four centers in North Carolina between 2008 and 2013. Surgical data collected by sites for submission to the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) and the North Carolina CHD Lifespan Database were queried. There were 715 patients with STS records; 558 linked to the NC-CHD database. Patients with prenatal diagnosis had a lower incidence of preoperative risk factors, including need for mechanical ventilation and presence of shock. However, prenatally diagnosed patients had worse short-term outcomes, including higher operative mortality, higher incidence of select postoperative complications, and longer LOS. There was no difference in one-year mortality. Our findings are consistent with current literature which suggests that prenatal diagnosis of critical CHD is associated with a more optimized preoperative clinical status. However, we found that patients with prenatal diagnoses had less favorable postoperative outcomes. This needs to be investigated further, but may be secondary to patient-specific factors, such as CHD disease severity.
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Affiliation(s)
- Ashley N Dischinger
- Department of Pediatrics, Division of Pediatric Cardiology, Duke University School of Medicine, 2301 Erwin Road, #7506, Durham, NC, USA.
| | - Jennifer S Li
- Department of Pediatrics, Division of Pediatric Cardiology, Duke University School of Medicine, 2301 Erwin Road, #7506, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Hillary Mulder
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Tracy Spears
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Karen E Chiswell
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Timothy M Hoffman
- Department of Pediatrics, Division of Pediatric Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Robert J Hartman
- Department of Pediatrics, Division of Pediatric Cardiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Michael J Walsh
- Department of Pediatrics, Division of Pediatric Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Charlie J Sang
- Departmart of Pediatrics, Division of Pediatric Cardiology, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Lauren A Sarno
- Departmart of Pediatrics, Division of Pediatric Cardiology, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Joseph A Paolillo
- Atrium Health Levine Children's Congenital Heart Center, Charlotte, NC, USA
| | - Karl Welke
- Atrium Health Levine Children's Congenital Heart Center, Charlotte, NC, USA
| | - Alfred D'Ottavio
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Neeta J Sethi
- Department of Pediatrics, Division of Pediatric Cardiology, Duke University School of Medicine, 2301 Erwin Road, #7506, Durham, NC, USA
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9
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Paul EA, Cohen J, Geiger MK. Cardiac problems in the fetus: a review for pediatric providers. Curr Opin Pediatr 2023; 35:523-530. [PMID: 37466056 DOI: 10.1097/mop.0000000000001274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
PURPOSE OF REVIEW The aim of this study was to provide pediatric providers with a review of the diagnosis and management of fetal cardiac disease in the current era. RECENT FINDINGS Prenatal detection of congenital heart disease (CHD) has improved but is still imperfect. In experienced hands, fetal echocardiography can detect severe CHD as early as the first trimester and a majority of more subtle conditions in the second and third trimesters. Beyond detection, a prenatal diagnosis allows for lesion-specific counseling for families as well as for development of a multidisciplinary perinatal management plan, which may involve in-utero treatment. Given the diversity of cardiac diagnoses and the rarity of some, collaborative multicenter fetal cardiac research has gained momentum in recent years. SUMMARY Accurate diagnosis of fetal cardiac disease allows for appropriate counseling, pregnancy and delivery planning, and optimization of immediate neonatal care. There is potential for improving fetal CHD detection rates. Fetal interventions are available for certain conditions, and fetal and pediatric cardiac centers have developed management plans specific to the expected postnatal physiology.
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Affiliation(s)
- Erin A Paul
- Division of Pediatric Cardiology, Mount Sinai Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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10
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Deng DP, Qian T, Liu YH, Wu ZS, Lu T. Prenatal diagnosis, management, and outcomes of fetuses with tetralogy of Fallot in China after prenatal counseling: a prospective cohort study. Front Pediatr 2023; 11:1172282. [PMID: 37622084 PMCID: PMC10445125 DOI: 10.3389/fped.2023.1172282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/17/2023] [Indexed: 08/26/2023] Open
Abstract
Objective The study aimed to monitor fetuses with tetralogy of Fallot (TOF) after prenatal counseling and how it influenced the decision of parents to terminate the pregnancy. Methods Fetuses with isolated TOF diagnosed between January 2019 and December 2021 were prospectively enrolled. The follow-up period extended until termination or 6 months after the operation. Results Of the 1,026 fetuses diagnosed with cardiac defects, 129 were identified to have isolated TOF and completed the follow-up. A total of 55 (42.6%) fetuses were terminated, with larger maternal age (odds ratio: 0.893, 95% confidence interval: 0.806-0.989, P = 0.031) as the protective factor. The maternal anxiety score, gestational weeks, and pulmonary-to-aortic-diameter ratio lost significance in multivariate analysis. Subjectively, the two most common reasons for terminating the pregnancy were worries about the prognosis (41.8%) and concerns about the possible suffering of the unborn child (18.2%). The prenatal diagnosis was accurate in 73 of the 74 (98.6%) live births. Out of the 64 live births that underwent surgical repair in our center, 57 (89.1%) received primary repair, with a median age of 104 days, and 49 (76.6%) underwent valve-sparing repair. No perioperative death occurred. Conclusions Termination for fetuses with TOF remains common in China. Live births with TOF can be safely and effectively managed.
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Affiliation(s)
- Deng-pu Deng
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Tao Qian
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yu-hong Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhong-shi Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
- National Health Commission Key Laboratory of Birth Defects Research, Prevention, and Treatment, Changsha, China
| | - Ting Lu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
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Moon-Grady AJ, Donofrio MT, Gelehrter S, Hornberger L, Kreeger J, Lee W, Michelfelder E, Morris SA, Peyvandi S, Pinto NM, Pruetz J, Sethi N, Simpson J, Srivastava S, Tian Z. Guidelines and Recommendations for Performance of the Fetal Echocardiogram: An Update from the American Society of Echocardiography. J Am Soc Echocardiogr 2023; 36:679-723. [PMID: 37227365 DOI: 10.1016/j.echo.2023.04.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
| | - Mary T Donofrio
- Children's National Hospital, Washington, District of Columbia
| | | | | | - Joe Kreeger
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Wesley Lee
- Baylor College of Medicine, Houston, Texas
| | | | - Shaine A Morris
- Baylor College of Medicine, Houston, Texas; Texas Children's Hospital, Houston, Texas
| | - Shabnam Peyvandi
- University of California, San Francisco, San Francisco, California
| | | | - Jay Pruetz
- Children's Hospital of Los Angeles, Los Angeles, California
| | | | - John Simpson
- Evelina London Children's Hospital, London, United Kingdom
| | | | - Zhiyun Tian
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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12
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Schidlow DN, Gauvreau K, Bucholz EM, Bennett A, Lafranchi T, Pruetz J, Ronai C, Vergales J, Brown DW. Prenatal care coordination, racial and socioeconomic inequities, and pre- and post-operative outcomes in hypoplastic left heart syndrome. J Perinatol 2023; 43:378-384. [PMID: 36539560 DOI: 10.1038/s41372-022-01571-7] [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] [Received: 04/24/2022] [Revised: 11/03/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE We sought to identify associations between prenatal care coordination (PNC) and outcomes in hypoplastic left heart syndrome (HLHS). STUDY DESIGN We hypothesized that suboptimal PNC is associated with worse pre-operative status. HLHS patients from 2016 through 2019 were identified using a multicenter registry. Optimal PNC was defined as (1) a completed interdisciplinary conference and (2) closed-loop communication with the obstetric team. Associations between PNC and outcomes were identified. RESULTS Of 1441 patients, 1242 (86%) had prenatal diagnosis. Among those with a prenatal diagnosis, PNC was achieved in only 845 (68%). Suboptimal PNC was associated with adverse events (50% vs 40%, p < 0.001), inotrope need (19% vs 13%, p = 0.007), mechanical ventilation (22% vs 16%, p = 0.016), and parenteral feeding (60% vs 46%, p < 0.001). African-American race and non-commercial insurance were associated with a lower likelihood of optimal PNC (p = 0.006 and p < 0.001, respectively). CONCLUSION Improving PNC and overcoming racial and socioeconomic barriers are important targets to improve HLHS perinatal care.
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Affiliation(s)
- David N Schidlow
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Emily M Bucholz
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Amy Bennett
- Board of Directions, Sisters by Heart, Los Angeles, CA, USA
| | - Terra Lafranchi
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Jay Pruetz
- Division of Cardiology, Children's Hospital Los Angeles, Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Christina Ronai
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Jeffrey Vergales
- Department of Pediatrics, Division of Cardiology, University of Virginia, Charlottesville, VA, USA
| | - David W Brown
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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13
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Haxel CS, Johnson JN, Hintz S, Renno MS, Ruano R, Zyblewski SC, Glickstein J, Donofrio MT. Care of the Fetus With Congenital Cardiovascular Disease: From Diagnosis to Delivery. Pediatrics 2022; 150:189887. [PMID: 36317976 DOI: 10.1542/peds.2022-056415c] [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] [Accepted: 08/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The majority of congenital cardiovascular disease including structural cardiac defects, abnormalities in cardiac function, and rhythm disturbances can be identified prenatally using screening obstetrical ultrasound with referral for fetal echocardiogram when indicated. METHODS Diagnosis of congenital heart disease in the fetus should prompt assessment for extracardiac abnormalities and associated genetic abnormalities once maternal consent is obtained. Pediatric cardiologists, in conjunction with maternal-fetal medicine, neonatology, and cardiothoracic surgery subspecialists, should counsel families about the details of the congenital heart defect as well as prenatal and postnatal management. RESULTS Prenatal diagnosis often leads to increased maternal depression and anxiety; however, it decreases morbidity and mortality for many congenital heart defects by allowing clinicians the opportunity to optimize prenatal care and plan delivery based on the specific lesion. Changes in prenatal care can include more frequent assessments through the remainder of the pregnancy, maternal medication administration, or, in selected cases, in utero cardiac catheter intervention or surgical procedures to optimize postnatal outcomes. Delivery planning may include changing the location, timing or mode of delivery to ensure that the neonate is delivered in the most appropriate hospital setting with the required level of hospital staff for immediate postnatal stabilization. CONCLUSIONS Based on the specific congenital heart defect, prenatal echocardiogram assessment in late gestation can often aid in predicting the severity of postnatal instability and guide the medical or interventional level of care needed for immediate postnatal intervention to optimize the transition to postnatal circulation.
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Affiliation(s)
- Caitlin S Haxel
- The University of Vermont Children's Hospital, Burlington, Vermont
| | | | - Susan Hintz
- Stanford University, Lucille Salter Packard Children's Hospital, Palo Alto, California
| | - Markus S Renno
- University Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | | | - Julie Glickstein
- Columbia University Vagelos School of Medicine, Morgan Stanley Children's Hospital, New York, New York
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14
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Słodki M, Copel JA, Rizzo G, Araujo Junior E, Axt-Fliedner R, Abuhamad A, Simpson LL, Lee W, DeVore G, Bahado-Singh R, Preis K, Respondek-Liberska M. Fetal Cardiology: Is It Time to Establish a Separate Independent Medicine Subspeciality? Pediatr Cardiol 2022; 43:1676-1677. [PMID: 35606573 DOI: 10.1007/s00246-022-02936-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/16/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Maciej Słodki
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland.
| | - Joshua A Copel
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Università' Roma Tor Vergata, Rome, Italy
| | - Edward Araujo Junior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Roland Axt-Fliedner
- Department of Obstetrics and Gynecology, Justus-Liebig University, Giessen, Germany
| | - Alfred Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Lynn L Simpson
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, USA
| | - Wesley Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Greggory DeVore
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Ray Bahado-Singh
- Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Krzysztof Preis
- Department of Obstetrics, Medical University of Gdańsk, Gdańsk, Poland
| | - Maria Respondek-Liberska
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
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15
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Weissmann-Brenner A, Domniz N, Meyer R, Weissbach T, Elkan T, Salem Y, Bart Y, Kassif E, Weisz B. Delivery Outcome of Fetuses with Congenital Heart Disease-Is It Influenced by Prenatal Diagnosis? J Clin Med 2022; 11:jcm11144075. [PMID: 35887840 PMCID: PMC9319522 DOI: 10.3390/jcm11144075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/12/2022] [Accepted: 07/11/2022] [Indexed: 01/27/2023] Open
Abstract
Objective: The objective of this study is to assess the delivery outcomes of neonates with congenital heart defects (CHD), and to explore the effect of prenatal diagnosis on these outcomes. Methods: A retrospective study including singleton deliveries between 2011 and 2020. All singleton neonates delivered at >24 weeks of gestation were included in this study. Fetuses with known prenatal anomalies other than CHD were excluded from this study. Pregnancy and neonatal outcomes were analyzed. A comparison was made between pregnancies with CHD and controls; and between pregnancies with prenatal diagnosis of CHD and postnatal diagnosis of CHD. Results: A total of 1598 neonates with CHD (688, 43.1% diagnosed prenatally) comprised the study group, compared to 85,576 singleton controls. Pregnancies with CHD had significantly increased BMI before pregnancy, suffered more from diabetes and chronic hypertension, had more inductions of labor, and had more cesarean deliveries (CD) including both elective CD and urgent CD due to non-reassuring fetal monitor (NRFHR) (OR = 1.75; 95%CI 1.45−2.14). Prenatal diagnosis of CHD is associated with a significant increased rate of induction of labor compared to postnatal diagnosis of CHD (OR = 1.59; 95% CI 1.15−2.22), but did not affect the mode of delivery including the rate of CD and CD due to non-reassuring fetal heart rate (NRFHR). Gestational age at birth and birthweight were significantly lower in pregnancies with CHD compared to controls, with no difference between prenatal to postnatal diagnosis of the anomaly. Neonates with CHD had a higher incidence of hypoxic ischemic encephalopathy and seizures compared to controls without any impact by prenatal diagnosis. Conclusion: Prenatal diagnosis of CHD is associated with an increased rate of induction of labor, with no increased rate of CD and CD due to NRFHR. The 5-min Apgar score is lower in pregnancies with postnatal diagnosis of CHD.
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Affiliation(s)
- Alina Weissmann-Brenner
- Institute of Obstetrical and Gynecological Imaging, The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; (N.D.); (R.M.); (T.W.); (T.E.); (Y.B.); (E.K.); (B.W.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- Correspondence: ; Tel.: +972-3-530-8116; Fax: +972-3-530-3168
| | - Noam Domniz
- Institute of Obstetrical and Gynecological Imaging, The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; (N.D.); (R.M.); (T.W.); (T.E.); (Y.B.); (E.K.); (B.W.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Raanan Meyer
- Institute of Obstetrical and Gynecological Imaging, The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; (N.D.); (R.M.); (T.W.); (T.E.); (Y.B.); (E.K.); (B.W.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Tal Weissbach
- Institute of Obstetrical and Gynecological Imaging, The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; (N.D.); (R.M.); (T.W.); (T.E.); (Y.B.); (E.K.); (B.W.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Tal Elkan
- Institute of Obstetrical and Gynecological Imaging, The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; (N.D.); (R.M.); (T.W.); (T.E.); (Y.B.); (E.K.); (B.W.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Yishai Salem
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- Pediatric Cardiology Unit, Department of Pediatrics, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel
| | - Yossi Bart
- Institute of Obstetrical and Gynecological Imaging, The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; (N.D.); (R.M.); (T.W.); (T.E.); (Y.B.); (E.K.); (B.W.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Eran Kassif
- Institute of Obstetrical and Gynecological Imaging, The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; (N.D.); (R.M.); (T.W.); (T.E.); (Y.B.); (E.K.); (B.W.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Boaz Weisz
- Institute of Obstetrical and Gynecological Imaging, The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel; (N.D.); (R.M.); (T.W.); (T.E.); (Y.B.); (E.K.); (B.W.)
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
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16
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Słodki M, Respondek-Liberska M. Fetal echocardiography: One of the most important tools in fetal diagnosis and assessing wellbeing. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:636-638. [PMID: 35674056 DOI: 10.1002/jcu.23216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Maciej Słodki
- Faculty of Health Sciences, The Mazovian State University, Plock, Poland
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Maria Respondek-Liberska
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Department of Diagnosis and Prevention of Fetal Malformations, Medical University of Lodz, Lodz, Poland
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17
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Levy PT, Thomas AR, Wethall A, Perez D, Steurer M, Ball MK. Rethinking Congenital Heart Disease in Preterm Neonates. Neoreviews 2022; 23:e373-e387. [PMID: 35641458 DOI: 10.1542/neo.23-6-e373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Congenital heart disease (CHD) and prematurity are the leading causes of infant mortality in the United States. Importantly, the combination of prematurity and CHD results in a further increased risk of mortality and significant morbidity. The key factors in these adverse outcomes are not well understood, but likely include maternal-fetal environment, perinatal and neonatal elements, and challenging postnatal care. Preterm neonates with CHD are born with "double jeopardy": not only do they experience challenges related to immaturity of the lungs, brain, and other organs, but they also must undergo treatment for cardiac disease. The role of the neonatologist caring for preterm infants with CHD has changed with the evolution of the field of pediatric cardiac critical care. Increasingly, neonatologists invested in the cardiovascular care of the newborn with CHD engage at multiple stages in their course, including fetal consultation, delivery room management, preoperative care, and postoperative treatment. A more comprehensive understanding of prematurity and CHD may inform clinical practice and ultimately improve outcomes in preterm infants with CHD. In this review, we discuss the current evidence surrounding neonatal and cardiac outcomes in preterm infants with CHD; examine the prenatal, perinatal, and postnatal factors recognized to influence these outcomes; identify knowledge gaps; consider research and clinical opportunities; and highlight the ways in which a neonatologist can contribute to the care of preterm infants with CHD.
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Affiliation(s)
- Philip T Levy
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Alyssa R Thomas
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Ashley Wethall
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Danielle Perez
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Martina Steurer
- Department of Pediatrics, University of California San Francisco, San Francisco, CA.,Department of Epidemiology and Biostatistics, California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA
| | - Molly K Ball
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH.,Division of Neonatology, The Ohio State University Wexner Medical Center, Columbus, OH
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18
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Słodki M. Dextro-transposition of great vessels: difficult to detect prenatally, one of the most dangerous and one of the best prognosed. Transl Pediatr 2022; 11:783-788. [PMID: 35800282 PMCID: PMC9253946 DOI: 10.21037/tp-22-163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Maciej Słodki
- Faculty of Health Sciences, The Mazovian State University, Plock, Poland.,Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
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19
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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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20
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Management of Hypertrophic Cardiomyopathy in a Newborn with Dextro-Transposition of the Great Arteries. Pediatr Cardiol 2022; 43:926-929. [PMID: 35307751 DOI: 10.1007/s00246-022-02874-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
Impaired maternal glucose metabolism during pregnancy can have significant effects on the cardiovascular system of the developing fetus. Early in pregnancy the teratogenic effects may lead to structural heart defects, while later in gestation a form of hypertrophic cardiomyopathy can develop due to overgrowth driven by fetal hyperinsulinism. We describe an infant with the uncommon combination of both dextro-transposition of the great arteries and hypertrophic cardiomyopathy. We emphasize the importance of a longitudinal multi-disciplinary approach, from fetal diagnosis to post-operative management, that allowed for an excellent outcome in this rare combination of severe cardiac malformations.
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21
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Hu Q, Deng C, Zhu Q, Yang X, Liu H, Liao H, Wang X, Yu H. Dextro-transposition of the great arteries in one twin: case reports and literature review. Transl Pediatr 2022; 11:601-609. [PMID: 35558975 PMCID: PMC9085950 DOI: 10.21037/tp-21-569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/25/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Dextro-transposition of the great arteries (D-TGA) is a rare congenital heart disease, as it affects only 0.02-0.05% of live births. It is the second most common cyanotic heart disease following Tetralogy of Fallot. It has a male predominance. Fetal echocardiography is an optimal method for prenatal diagnosis of fetal D-TGA. In twin pregnancies, fetal D-TGA in one twin is very rare, especially in monochorionic-diamniotic twin pregnancies. Herein, we report a case of D-TGA in one twin in two dichorionic-diamniotic twin pregnancies and one monochorionic-diamniotic twin pregnancy from January 2018 to June 2021. CASE DESCRIPTION One twin with D-TGA was diagnosed by fetal echocardiography in the second trimester, and the co-twin was normal in all three cases. A multidisciplinary team provided extensive counseling regarding the D-TGA twin and the co-twin, and adequate perinatal management was provided. In cases 1, 2, and 3, the mothers underwent cesarean sections at 37 weeks + 2 days, 34 weeks + 5 days, and 36 weeks + 1 day, respectively. In case 1, which involved a female D-TGA neonate with birth weight 2,410 g, an emergent atrial septostomy was performed at 20 h after birth, and the neonate underwent atrial switch operation (ASO) 24 days after birth. In case 2, involving a male D-TGA neonate with a birth weight of 2,380 g, ASO was performed 24 days after birth. In case 3, involving a female D-TGA neonate with birth weight 2,240 g, ASO was performed 19 days after birth and delayed sternal closure was performed 4 days later. All six infants showed normal development during follow-up. CONCLUSIONS Early antenatal diagnosis of D-TGA in one fetus of a twin pregnancy is significantly important. A multidisciplinary team should carry individual evaluation and integrated management of the D-TGA twin and co-twin during the pregnancy and perinatal period. After birth, delayed ductus arteriosus closure in the D-TGA twins should be performed when necessary and individualized timings for arterial switch operation should be considered.
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Affiliation(s)
- Qing Hu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Chunyan Deng
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Qi Zhu
- Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.,Department of Ultrasonic Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiaoyan Yang
- Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.,Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Hongyan Liu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Hua Liao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xiaodong Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Haiyan Yu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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22
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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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23
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Gireadă R, Socolov D, Mihălceanu E, Matasariu R, Ursache A, Akad M, Bujor I, Scripcariu I, Popa RF, Socolov R. The Additional Role of the 3-Vessels and Trachea View in Screening for Congenital Heart Disease. Medicina (B Aires) 2022; 58:medicina58020262. [PMID: 35208585 PMCID: PMC8875090 DOI: 10.3390/medicina58020262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 11/19/2022] Open
Abstract
Background and Objectives: Although frequent and associated with high mortality and morbidity rate, congenital heart disease (CHD) has a suboptimal prenatal detection rate, with significant variation according to the scanning protocol. The aim of this study was to evaluate the role of the 3-vessels and trachea view (3VT) in detecting CHD, with or without the use of Color Doppler, with an emphasis on major CHD. Materials and Methods: We performed a retrospective study on 1596 unselected pregnant patients presenting at 11–37 weeks of gestation for a routine anomaly scan. We selected all CHD cases, and we analyzed the performance of the 4-chamber (4C) and 3VT view in detecting CHD. Results: A total of 46 fetuses with CHD were identified, yielding a 2.86% overall incidence, and 0.87% for major CHD. Grayscale 4C detected 47.8% of all CHD, going up to 71.7% by adding grayscale 3VT, with no major CHD remaining undetected by combining grayscale 4C and 3VT. Conclusions: Grayscale 4C and 3VT views are effective in detecting major CHD, thus proving their utility even in a low resource setting.
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Affiliation(s)
- Roxana Gireadă
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy ‘Gr. T. Popa’, 700115 Iaşi, Romania; (R.G.); (D.S.); (E.M.); (A.U.); (M.A.); (I.B.); (R.F.P.); (R.S.)
| | - Demetra Socolov
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy ‘Gr. T. Popa’, 700115 Iaşi, Romania; (R.G.); (D.S.); (E.M.); (A.U.); (M.A.); (I.B.); (R.F.P.); (R.S.)
- Department of Obstetrics and Gynecology, Cuza Vodă Hospital, 700038 Iaşi, Romania
| | - Elena Mihălceanu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy ‘Gr. T. Popa’, 700115 Iaşi, Romania; (R.G.); (D.S.); (E.M.); (A.U.); (M.A.); (I.B.); (R.F.P.); (R.S.)
- Department of Obstetrics and Gynecology, Cuza Vodă Hospital, 700038 Iaşi, Romania
| | - Roxana Matasariu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy ‘Gr. T. Popa’, 700115 Iaşi, Romania; (R.G.); (D.S.); (E.M.); (A.U.); (M.A.); (I.B.); (R.F.P.); (R.S.)
- Department of Obstetrics and Gynecology, Cuza Vodă Hospital, 700038 Iaşi, Romania
- Correspondence: (R.M.); (I.S.)
| | - Alexandra Ursache
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy ‘Gr. T. Popa’, 700115 Iaşi, Romania; (R.G.); (D.S.); (E.M.); (A.U.); (M.A.); (I.B.); (R.F.P.); (R.S.)
| | - Mona Akad
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy ‘Gr. T. Popa’, 700115 Iaşi, Romania; (R.G.); (D.S.); (E.M.); (A.U.); (M.A.); (I.B.); (R.F.P.); (R.S.)
| | - Iuliana Bujor
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy ‘Gr. T. Popa’, 700115 Iaşi, Romania; (R.G.); (D.S.); (E.M.); (A.U.); (M.A.); (I.B.); (R.F.P.); (R.S.)
| | - Ioana Scripcariu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy ‘Gr. T. Popa’, 700115 Iaşi, Romania; (R.G.); (D.S.); (E.M.); (A.U.); (M.A.); (I.B.); (R.F.P.); (R.S.)
- Department of Obstetrics and Gynecology, Cuza Vodă Hospital, 700038 Iaşi, Romania
- Correspondence: (R.M.); (I.S.)
| | - Radu Florin Popa
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy ‘Gr. T. Popa’, 700115 Iaşi, Romania; (R.G.); (D.S.); (E.M.); (A.U.); (M.A.); (I.B.); (R.F.P.); (R.S.)
| | - Răzvan Socolov
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy ‘Gr. T. Popa’, 700115 Iaşi, Romania; (R.G.); (D.S.); (E.M.); (A.U.); (M.A.); (I.B.); (R.F.P.); (R.S.)
- Department of Obstetrics and Gynecology, Elena Doamna Hospital, 700398 Iaşi, Romania
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Jadczak A, Respondek-Liberska M, Sokołowski Ł, Chrzanowski J, Rizzo G, Araujo Júnior E, Bravo-Valenzuela NJ, Axt-Fliedner R, Słodki M. Hypoplastic left heart syndrome with prenatally diagnosed foramen ovale restriction: diagnosis, management and outcome. J Matern Fetal Neonatal Med 2022; 35:291-298. [PMID: 31986935 DOI: 10.1080/14767058.2020.1716717] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Despite advances in prenatal diagnosis and postnatal intervention/surgery methods, patients with Hypoplastic Left Heart Syndrome (HLHS) and coexisting foramen oval restriction still achieve high mortality rates. Our objective was to determine survival predictors and to find answers to, why restriction develops in some, but not others. METHODS We performed a retrospective analysis of prenatal history and postnatal sequel of 22 patients with HLHS and foramen ovale restriction between 2008 and 2017. RESULTS There were 11 survivors and 11 nonsurvivors. The most significant difference between the two groups pertained to the average time of foramen ovale restriction diagnosis which was 33 weeks for survivors and 28 weeks for nonsurvivors (p = .0416) and the duration of in-utero restriction (9 versus 5 weeks, p = .0213). Twenty patients (20/22) exhibited possible signs of infection. CONCLUSIONS (1) Earlier development and longer presence of foramen ovale restriction in the setting of HLHS is associated with higher short-term mortality regardless of the degree of restriction. (2) Ratio of forward pulmonary vein flow to reverse flow (f/r) expressed as a velocity-time integral (VTI) is a good emergent intervention predictor, but it does not correlate with foramen ovale size and maximal velocity, nor does it influence survival rates. (3) Ultrasonographic signs of possible infection of the fetus is a potential risk factor of foramen ovale restriction development in patients with HLHS.
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Affiliation(s)
- Anna Jadczak
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lódz, Poland
| | - Maria Respondek-Liberska
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lódz, Poland
- Department of Diagnoses and Prevention of Fetal Malformations, Medical University of Lodz, Lódz, Poland
| | - Łukasz Sokołowski
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lódz, Poland
- Department of Obstetrics and Gynecology, Polish Mother's Memorial Hospital, Lódz, Poland
| | - Jędrzej Chrzanowski
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lódz, Poland
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lódz, Poland
| | - Giuseppe Rizzo
- Department of Maternal Fetal Medicine, Ospedale Cristo Re Roma, Università degli Studi di Roma "Tor Vergata", Rome, Italy
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
- Medical Course, Municipal University of São Caetano do Sul (USCS), São Paulo, Brazil
| | | | - Roland Axt-Fliedner
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University Hospital UKGM, Justus-Liebig University, Giessen, Germany
| | - Maciej Słodki
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lódz, Poland
- Faculty of Health Sciences, The Mazovian State University in Plock, Poland
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Bravo-Valenzuela NJM, Peixoto AB, Araujo Júnior E. Prenatal diagnosis of total anomalous pulmonary venous connection: 2D and 3D echocardiographic findings. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:240-247. [PMID: 33398887 DOI: 10.1002/jcu.22973] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/14/2020] [Accepted: 12/28/2020] [Indexed: 06/12/2023]
Abstract
Total anomalous pulmonary venous connection (TAPVC) is a rare cyanotic congenital heart disease that accounts for less than 1% of all congenital heart diseases. TAPVC is characterized by the absence of pulmonary venous drainage into the left atrium. It is underdiagnosed in utero, with prenatal detection rates of less than 1.4%. The prenatal diagnosis of TAPVC affects the postnatal outcome, particularly in obstructive forms (critical TAPVC), since planned delivery and perinatal management are mandatory. Thus, identifying the ultrasound key markers of TAPVC is important for the prenatal diagnosis and perinatal assistance. The ventricular size discrepancy (right ventricle > left ventricle) can be a useful marker. Furthermore, the increased retroatrial distance between the left atrium and the aorta could be a diagnostic marker for prenatal TAPVC, especially when the left atrium is small. Three- (3D) and four-dimensional ultrasonography may improve the prenatal diagnosis of TAPVC. This study reviews the two (2D) and 3D ultrasonographic markers used in the antenatal diagnosis of TAPVC, with a focus on the tools that can be used by sonographers, obstetricians, and fetal medicine specialists to improve the prenatal diagnosis of TAPVC, and when to refer the case to a fetal cardiac specialist.
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Affiliation(s)
| | - Alberto Borges Peixoto
- Mario Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba, Brazil
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
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The key role of the pediatric radiologist in developing a multidisciplinary fetal center. Pediatr Radiol 2020; 50:1801-1809. [PMID: 33252750 DOI: 10.1007/s00247-020-04702-4] [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] [Received: 11/20/2019] [Revised: 04/10/2020] [Accepted: 05/05/2020] [Indexed: 12/25/2022]
Abstract
With the demand for fetal imaging and fetal care programs on the rise, the authors of this manuscript review the components of building a successful fetal imaging center. Creating an environment that engages a multidisciplinary team, utilizing a central coordinator to review clinical and psychosocial aspects of each patient, and ensuring ongoing research and quality control are essential components to the success of growing a program.
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Słodki M, Soroka M, Rizzo G, Respondek-Liberska M. Prenatal Atrioventricular Septal Defect (AVSD) as a planned congenital heart disease with different outcome depending on the presence of the coexisting extracardiac abnormalities (ECA) and/or malformations (ECM). J Matern Fetal Neonatal Med 2020; 33:2635-2641. [PMID: 30514144 DOI: 10.1080/14767058.2018.1556254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Prenatal atrioventricular septal defect (AVSD) on frequent occasions coexists with other cardiac or extracardiac abnormalities or malformation which may change the prognosis and the management with the fetus and the newborn. The aim of the research was to assess the prognosis and the outcome of prenatally diagnosed AVSD based on the classification which also includes coexisting extracardiac abnormalities and malformations as well as its influence on the prenatal consultation.Methods: It was a retrospective analysis of 113 patients with prenatally diagnosed AVSD. The group was selected out of 871 patients with CHD. Out of 113 fetuses with AVSD we exclude those in whom AVSD was coexistent with other cardiac malformations (n = 41). Extracardiac abnormalities [ECA] were defined as problems which do not require surgical intervention after delivery, they were usually markers of a genetic syndrome. Extracardiac malformations [ECM] were defined as problems requiring surgical interventions after delivery or lethal malformations. All 72 fetuses with an isolated AVSD were classified to one of the three groups: (1) Simple AVSD - (sAVSD) - a fetus with isolated AVSD without coexisting ECA and ECM (n = 6), (2) sAVSD + ECA - a fetus with isolated AVSD, with coexisting ECA (n = 28), (3) sAVSD + ECM - a fetus with isolated AVSD, with coexisting ECM (n = 38).Results: The pregnancy from the groups sAVSD + ECM were, in fact, more often referred to the prenatal cardiology centers on account of the existing ECM (p=.03). There were no differences between the two subgroups in regard to: the mean age of the pregnancy, the mean age of the fetus at the time of diagnosis and during diagnostic testing at the referral center, the gender of the fetus. An increased nuchal translucency (NT) was most often found in fetuses from the group AVSD + ECA (n = 13/23), which was connected with more frequent occurrence of abnormal karyotype (p=.048). The trisomy 21 more frequently referred to pregnancy with sAVSD + ECA than those with sAVSD + ECM (p=.0006). In the group sAVSD + ECM there was the highest number of fetuses small for the gestational age detected -48.65% (p=.01). Most often premature deliveries were found in the group sAVSD + ECM (72.73%). The duration of gestation in the group sAVSD + ECM turned out to be much shorter than that in the group with the isolated sAVSD (p=.01) and sAVSD + ECA (p=.03). The lowest Apgar score was in the newborns from the group sAVSD + ECM (p=.002). Longer period of gestation was connected with the higher score on Apgar scale (R = 0.541; p=.001). The average delivery weight of the newborns was the lowest in the group sAVSD + ECM (p=.04). sAVSD + ECM was connected with the significantly higher death rate than the isolated sAVSD (p=.0047) or sAVSD + ECA (p<.00001). The fatality rate of the newborns/ fetuses from the pregnancies lasting less than 37 weeks turned out to be much higher than in the case of the remaining pregnancies (sAVSD p=.002).Conclusions: (1) The majority of fetuses with AVSD remained the patients of just obstetricians and prenatal cardiologists because of highly heterogeneous of the coexisting malformations and abnormalities and since they perish in the period of fetal or neonatal life usually they are not seen by the pediatricians or cardiac surgeons. (2) The classification of the AVSD in fetus to a particular group of the prognostic classification of the fetal heart defects helps to plan perinatal management and supplies information regarding the prognosis. (3) The highest mortality rate was in a group of AVSD + ECM, probably due to shorter time of pregnancy duration, fetuses grow restriction and low Apgar score in 1 minute of life.
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Affiliation(s)
- Maciej Słodki
- Faculty of Health Sciences, the State University of Applied Sciences, Płock, Poland
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lódz, Poland
| | - Małgorzata Soroka
- Faculty of Health Sciences, the State University of Applied Sciences, Płock, Poland
| | - Giuseppe Rizzo
- Department of Maternal Fetal Medicine, Ospedale Cristo Re Roma, Università di Roma Tor Vergata, Italy
- Department of Obstetrics and Gynecology The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Maria Respondek-Liberska
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lódz, Poland
- Department of Diagnoses and Prevention of Fetal Malformations, Medical University of Lodz, Poland
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Family-Centered Management of Birth Defects Diagnosis and Referral in Hospital Settings in Florida. Matern Child Health J 2020; 24:777-786. [DOI: 10.1007/s10995-020-02914-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Cuneo BF, Olson CA, Haxel C, Howley L, Gagnon A, Benson DW, Kaizer AM, Thomas JF. Risk Stratification of Fetal Cardiac Anomalies in an Underserved Population Using Telecardiology. Obstet Gynecol 2020; 134:1096-1103. [PMID: 31599844 DOI: 10.1097/aog.0000000000003502] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate a fetal telecardiology program in a medically underserved area. METHODS We conducted a prospective case series of pregnant women at 18-38 weeks of gestation with risk factors for fetal congenital heart disease. Obstetric ultrasonographers performed fetal echocardiograms (local site) that were read in real time. The results were given to the mother by a fetal cardiologist at a children's hospital 243 miles and two mountain passes away (distant site). We evaluated the fetal telecardiology program in five domains: 1) education of obstetric ultrasonographers before initiation of telecardiology services, 2) process and efficiency, 3) patient satisfaction, 4) economic effects, and 5) accuracy of cardiac diagnosis and success of risk stratification. RESULTS The program was initiated on November 12, 2015, and here we describe its first 37 months. Over the initial training period of 3 months and about 70 examinations, obstetric ultrasonographers improved their identification of fetal congenital heart disease. Telecardiology was performed once a week and also for suspected fetal congenital heart disease or arrhythmia outside clinic hours, for a total of 455 examinations. All mothers preferred having their fetal cardiac evaluations performed locally as opposed to traveling to the distant center. The estimated cost to parents for fetal cardiac evaluation at the distant center was nine times greater than that of telecardiology ($581 vs $61). Congenital heart disease or arrhythmia was diagnosed in 28 and 15 fetuses, respectively; there was one false-negative result. All fetuses were correctly risk-stratified with respect to delivery location. CONCLUSIONS Neither diagnostic quality nor patient satisfaction were sacrificed with telecardiology. The program was feasible, empowered the local health care providers and ultrasonographers, offered strong economic advantages to families, and offered the benefit of timely standard-of-care, face-to-face consultation without travel. Based on the success of this program, further studies are warranted to assess its replicability.
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Affiliation(s)
- Bettina F Cuneo
- Colorado Fetal Care Center, the Heart Institute, the Department of Pediatrics, and the TeleHealth Department, Children's Hospital Colorado, and the University of Colorado School of Medicine, Aurora, and St. Mary's Medical Center, Grand Junction, Colorado; the Department of Pediatrics, Children's Hospital of Wisconsin; Milwaukee Wisconsin; and the Department of Biostatistics and Informatics, University of Colorado, Aurora, Colorado
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Neonatal and maternal outcomes of pregnancies with a fetal diagnosis of congenital heart disease using a standardized delivery room management protocol. J Perinatol 2020; 40:316-323. [PMID: 31611616 DOI: 10.1038/s41372-019-0528-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We sought to determine if fetuses with prenatally diagnosed congenital heart disease (CHD) were more likely to undergo cesarean delivery in the setting of a non-reassuring fetal heart rate tracing (NRFHT) and to determine if those fetuses were more likely to have a fetal acidosis. STUDY DESIGN A retrospective cohort study of neonates prenatally diagnosed with CHD from August 2010 to July 2016. The control group consisted of gestational age matched controls without CHD. RESULTS Each group consisted of 143 patients. The most common reason for cesarean delivery was a NRFHT (control 31% vs CHD 35%, p = 0.67). Fetal acidosis was a rare outcome occurring in only five controls (3.5%) and 11 cases (7.7%) (p = 0.12). CONCLUSION These findings demonstrate that with multidisciplinary care coordination, fetuses with a prenatal diagnosis of CHD have similar cesarean rates, labor and delivery management, and delivery room compromise as healthy fetuses.
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Pruetz JD, Wang SS, Noori S. Delivery room emergencies in critical congenital heart diseases. Semin Fetal Neonatal Med 2019; 24:101034. [PMID: 31582282 DOI: 10.1016/j.siny.2019.101034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Transition from fetal to postnatal life is a complex process. Even in the absence of congenital heart disease, about 4-10% of newborns require some form of assistance in the delivery room. Neonates with complex congenital heart disease should be expected to require significant intervention and thus the resuscitation team must be well prepared for such a delivery. Prenatal assessment including fetal and maternal health in general and detailed information on fetal heart structure, function and hemodynamics in particular are crucial for planning the delivery and resuscitation. In addition, understanding the impact of cardiac structural anomaly and associated altered blood flow on early postnatal transition is essential for success of resuscitation in the delivery room. In this article, we will briefly review transitional circulation focusing on altered hemodynamics of the complex congenital heart diseases and then discuss the process of preparing for these high-risk deliveries. Finally, we will review the pathophysiology resulting from the cardiac structural anomaly with resultant altered fetal circulation and discuss delivery room management of specific critical congenital heart diseases.
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Affiliation(s)
- Jay D Pruetz
- Heart Institute, Division of Cardiology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States; Department of Obstetrics & Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Shuo Sue Wang
- Heart Institute, Division of Cardiology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Shahab Noori
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA United States.
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Cruz-Lemini M, Nieto-Castro B, Luna-Garcia J, Juarez-Martinez I, Martínez-Rivera M, Bermudez-Rojas MDLL, Rebolledo-Fernández C, Cruz-Martinez R. Prenatal diagnosis of congenital heart defects: experience of the first Fetal Cardiology Unit in Mexico. J Matern Fetal Neonatal Med 2019; 34:1529-1534. [PMID: 31257961 DOI: 10.1080/14767058.2019.1638905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The purpose of this article was to describe our experience with the prenatal diagnosis of CHD in patients referred to our Fetal Cardiology Unit. METHODS Prospective cohort study of consecutive fetuses referred for advanced fetal echocardiography to our Fetal Cardiology Unit during a 3-year period (September 2015-September 2018). RESULTS Totally 809 fetuses were evaluated, with 1263 fetal advanced echocardiographies performed. Suspected cardiac abnormality was the most common indication for referral (62.2%). Only 7.3% of patients had known morbidities or risk factors for CHD. Mean gestational age at first examination was 25.6 ± 6.4 weeks. A total of 528 (65.3%) fetuses were found to have a cardiac defect: 40.7% had isolated CHD while 24.6% had associated anomalies. The most common defects found were ventricular septal defects (20.3%), followed by conotruncal defects (9.7%), hypoplastic left heart syndrome (9.3%), fetal arrhythmias (8.9%), and venous anomalies (8.7%). 31.6% presented abnormal genetic studies, the most frequent being Down syndrome (23/212, 10.8%), followed by DiGeorge syndrome (11/212, 5.2%). CONCLUSIONS Prenatal screening and diagnosis of CHD in Mexico are feasible, with suspected cardiac abnormality being the main reason for referral to a specialized Fetal Cardiology Unit. Efforts must be made to make screening available to the general population in the first and second trimesters of pregnancy by fetal medicine or trained specialists, in order to identify fetal CHD and offer advanced echocardiography, genetic studies, timely fetal cardiac intervention in selected cases, and delivery in tertiary centers, to improve overall survival.
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Affiliation(s)
- Monica Cruz-Lemini
- Fetal Medicine Mexico, Fetal Surgery Unit, Children and Women's Specialty Hospital of Queretaro, Queretaro, Mexico
| | - Belen Nieto-Castro
- Fetal Medicine Mexico, Fetal Surgery Unit, Children and Women's Specialty Hospital of Queretaro, Queretaro, Mexico
| | - Jonahtan Luna-Garcia
- Fetal Medicine Mexico, Fetal Surgery Unit, Children and Women's Specialty Hospital of Queretaro, Queretaro, Mexico
| | - Israel Juarez-Martinez
- Fetal Medicine Mexico, Fetal Surgery Unit, Children and Women's Specialty Hospital of Queretaro, Queretaro, Mexico
| | | | | | - Carlos Rebolledo-Fernández
- Fetal Medicine Mexico, Fetal Surgery Unit, Children and Women's Specialty Hospital of Queretaro, Queretaro, Mexico
| | - Rogelio Cruz-Martinez
- Fetal Medicine Mexico, Fetal Surgery Unit, Children and Women's Specialty Hospital of Queretaro, Queretaro, Mexico
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Kim ST, Song J, Huh J, Kang IS, Yang JH, Jun TG, Oh SY, Choi SJ, Roh CR. The Effect of Multidisciplinary Approach on the Birth Rate of Fetuses with Prenatally Diagnosed Congenital Heart Disease. J Korean Med Sci 2019; 34:e170. [PMID: 31222983 PMCID: PMC6589403 DOI: 10.3346/jkms.2019.34.e170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/27/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study aimed to determine the effect of a multidisciplinary approach on the birth rate of fetuses with prenatally diagnosed congenital heart diseases (CHDs). METHODS Among the fetuses of 724 gravidas who underwent fetal echocardiography in Samsung Medical Center from January 2013 to June 2017, 463 fetuses with normal cardiac structure, arrhythmia or simple left-to-right shunt were excluded, and the remaining 261 were included in the study. The subjects were subdivided into groups based on whether they were consulted multidisciplinarily, that is, consulted simultaneously by pediatric cardiologists, obstetricians and pediatric cardiac surgeons or not. They were also categorized based on the initial fetal echocardiogram results. RESULTS Among the fetuses in the multidisciplinary group, 64.5% of the fetuses were given birth to, and the proportion was not different from that in the non-multidisciplinary group (68.6%, P = 0.48). The delivery rate in the multidisciplinary consultation group were 69.2% in the transposition of the great arteries group, 63.6% in the tetralogy of Fallot group, 68.8% in the pulmonary atresia or interrupted aortic arch group, 62.5% in the coarctation of aorta group, 60.0% in the atrioventricular septal defect group, 70.0% in the functional single ventricle group, and 55.6% in the hypoplastic left heart syndrome group; there were no significant differences between the 10 echocardiogram groups. However, when the subjects were categorized into Fontan repair group and biventricular repair group, the Fontan repair group showed a significant increase in the likelihood of delivery when a multidisciplinary approach was taken (P = 0.035). CONCLUSION When a fetus was diagnosed with a CHD where Fontan repair should be considered, a multidisciplinary approach resulted in increased possibility of delivery.
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Affiliation(s)
- Susan Taejung Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinyoung Song
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - June Huh
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - I Seok Kang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hyuk Yang
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Gook Jun
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suk Joo Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheong Rae Roh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Ge S, Maulik D. Introduction: From fetal echocardiography to fetal cardiology: A journey of over half a century. Echocardiography 2018; 34:1757-1759. [PMID: 29287140 DOI: 10.1111/echo.13776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/14/2017] [Indexed: 11/27/2022] Open
Abstract
In this Special Issue of the Journal, 8 review articles that represent the new developments and applications of fetal echocardiography and fetal cardiology for diagnosis, prognosis, and treatment of fetal cardiovascular disease are included. The goal was to provide an updated review of the evidence for the current and emerging use of fetal echocardiography and cardiac magnetic resonance, improved diagnosis of challenging congenital heart disease, new tools for evaluation of fetal systolic and diastolic function, better prognosis and risk stratification of newborns with congenital heart diseases, and new and promising therapies for fetuses with cardiovascular disease.
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Affiliation(s)
- Shuping Ge
- The Heart Center, St. Christopher's Hospital for Children and Drexel University College of Medicine, Philadelphia, PA, USA
| | - Dev Maulik
- University of Missouri, Columbia, MO, USA
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