1
|
Liu X, Zhang Y, Zhu H, Jia B, Wang J, He Y, Zhang H. Applications of artificial intelligence-powered prenatal diagnosis for congenital heart disease. Front Cardiovasc Med 2024; 11:1345761. [PMID: 38720920 PMCID: PMC11076681 DOI: 10.3389/fcvm.2024.1345761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
Artificial intelligence (AI) has made significant progress in the medical field in the last decade. The AI-powered analysis methods of medical images and clinical records can now match the abilities of clinical physicians. Due to the challenges posed by the unique group of fetuses and the dynamic organ of the heart, research into the application of AI in the prenatal diagnosis of congenital heart disease (CHD) is particularly active. In this review, we discuss the clinical questions and research methods involved in using AI to address prenatal diagnosis of CHD, including imaging, genetic diagnosis, and risk prediction. Representative examples are provided for each method discussed. Finally, we discuss the current limitations of AI in prenatal diagnosis of CHD, namely Volatility, Insufficiency and Independence (VII), and propose possible solutions.
Collapse
Affiliation(s)
- Xiangyu Liu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Key Laboratory of Data Science and Intelligent Computing, International Innovation Institute, Beihang University, Hangzhou, China
| | - Yingying Zhang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Key Laboratory of Data Science and Intelligent Computing, International Innovation Institute, Beihang University, Hangzhou, China
| | - Haogang Zhu
- Key Laboratory of Data Science and Intelligent Computing, International Innovation Institute, Beihang University, Hangzhou, China
- State Key Laboratory of Software Development Environment, Beihang University, Beijing, China
- School of Computer Science and Engineering, Beihang University, Beijing, China
| | - Bosen Jia
- School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand
| | - Jingyi Wang
- Echocardiography Medical Center Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China
| | - Yihua He
- Echocardiography Medical Center Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Beijing, China
| | - Hongjia Zhang
- Key Laboratory of Data Science and Intelligent Computing, International Innovation Institute, Beihang University, Hangzhou, China
- Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
| |
Collapse
|
2
|
Girdhar A, Ewer AK. Pulse Oximetry Screening for Critical Congenital Heart Defects in Newborn Babies. Crit Care Nurs Clin North Am 2024; 36:99-110. [PMID: 38296378 DOI: 10.1016/j.cnc.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Pulse oximetry screening (POS) was first described over 20 years ago. However, in recent years, major clinical trials have demonstrated consistent test accuracy for the detection of critical congenital heart defects (CCHD). International uptake of POS has progressed well over the last 10 years with most major high-income countries now recommending screening. This review describes the evidence base which has led to this, the current debate regarding choice of screening algorithm, and the future areas for further research.
Collapse
Affiliation(s)
- Anurag Girdhar
- Department of Neonatology, Birmingham Women's Hospital NHS Trust, Birmingham, United Kingdom
| | - Andrew K Ewer
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
3
|
Choi HJ, Song MK, Lee SY, Kim GB, Bae EJ, Park JS, Jun JK, Kwon HW, Lim HG, Kim WH. Trend of fetal echocardiography use and comparison of medical costs for congenital heart disease treatment based on fetal echocardiography use in a Korean single center. Front Pediatr 2023; 11:933623. [PMID: 37456570 PMCID: PMC10347520 DOI: 10.3389/fped.2023.933623] [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: 05/01/2022] [Accepted: 06/21/2023] [Indexed: 07/18/2023] Open
Abstract
Background The rate of the prenatal diagnosis of congenital heart disease is increasing along with advances in fetal echocardiography techniques. Here, we aimed to investigate the trend of the use of fetal echocardiography over time and to compare the medical costs of congenital heart disease treatment according to whether fetal echocardiography was performed. Methods We reviewed our hospital's database, and patients who underwent the first surgery for congenital heart disease within 30 days of birth during 2005-2007, 2011-2013, and 2017-2019 were included. The severity of congenital heart disease diagnosed in each case was evaluated according to The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Scores (STS-EACTS Mortality Scores) and Mortality Categories (STAT Mortality Categories). Results In total, 375 patients were analyzed, and fetal echocardiography use increased significantly after the 2010s compared with in 2005-2007 (19.1% vs. 39%, p = 0.032 in Mortality Category 1-3; 15.5% vs. 69.5%, p = 0.000 in Mortality Category 4-5). Additionally, the mean STS-EACTS Mortality Score was higher in prenatally diagnosed patients than in postnatally diagnosed patients (2.287 vs. 1.787, p = 0.001). In the recent period, there was no significant difference in hospitalization durations and medical costs according to whether or not fetal echocardiography was performed. Conclusions This single center study showed the use of fetal echocardiography is increasing. Further, prenatal diagnosis with fetal echocardiography causing no differences in medical costs in recent years. Therefore, we suggest that fetal echocardiography can be applied more widely without increasing the economic burden.
Collapse
Affiliation(s)
- Ho-Jung Choi
- Department of Pediatrics, Seoul National University Hospital, Seoul, Republic of Korea
| | - Mi-Kyoung Song
- Department of Pediatrics, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang-Yun Lee
- Department of Pediatrics, Seoul National University Hospital, Seoul, Republic of Korea
| | - Gi-Beom Kim
- Department of Pediatrics, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun-Jung Bae
- Department of Pediatrics, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joong-Shin Park
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jong-Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hye-Won Kwon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hong-Gook Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
4
|
Noben L, Lempersz C, van den Heuvel ER, Zhan Z, Vandenbussche FPHA, Coumans ABC, Haak MC, Vullings R, Oei SG, Clur SAB, van Laar JOEH. The electrical heart axis in fetuses with congenital heart disease, measured with non-invasive fetal electrocardiography. PLoS One 2022; 17:e0275802. [PMID: 36264863 PMCID: PMC9584524 DOI: 10.1371/journal.pone.0275802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To determine if the electrical heart axis in different types of congenital heart defects (CHD) differs from that of a healthy cohort at mid-gestation. METHODS Non-invasive fetal electrocardiography (NI-fECG) was performed in singleton pregnancies with suspected CHD between 16 and 30 weeks of gestation. The mean electrical heart axis (MEHA) was determined from the fetal vectorcardiogram after correction for fetal orientation. Descriptive statistics were used to determine the MEHA with corresponding 95% confidence intervals (CI) in the frontal plane of all fetuses with CHD and the following subgroups: conotruncal anomalies (CTA), atrioventricular septal defects (AVSD) and hypoplastic right heart syndrome (HRHS). The MEHA of the CHD fetuses as well as the subgroups was compared to the healthy control group using a spherically projected multivariate linear regression analysis. Discriminant analysis was applied to calculate the sensitivity and specificity of the electrical heart axis for CHD detection. RESULTS The MEHA was determined in 127 fetuses. The MEHA was 83.0° (95% CI: 6.7°; 159.3°) in the total CHD group, and not significantly different from the control group (122.7° (95% CI: 101.7°; 143.6°). The MEHA was 105.6° (95% CI: 46.8°; 164.4°) in the CTA group (n = 54), -27.4° (95% CI: -118.6°; 63.9°) in the AVSD group (n = 9) and 26.0° (95% CI: -34.1°; 86.1°) in the HRHS group (n = 5). The MEHA of the AVSD and the HRHS subgroups were significantly different from the control group (resp. p = 0.04 and p = 0.02). The sensitivity and specificity of the MEHA for the diagnosis of CHD was 50.6% (95% CI 47.5% - 53.7%) and 60.1% (95% CI 57.1% - 63.1%) respectively. CONCLUSION The MEHA alone does not discriminate between healthy fetuses and fetuses with CHD. However, the left-oriented electrical heart axis in fetuses with AVSD and HRHS was significantly different from the control group suggesting altered cardiac conduction along with the structural defect. TRIAL REGISTRATION Clinical trial registration number: NL48535.015.14.
Collapse
Affiliation(s)
- L. Noben
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
- * E-mail:
| | - C. Lempersz
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
| | - E. R. van den Heuvel
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Z. Zhan
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - F. P. H. A. Vandenbussche
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A. B. C. Coumans
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M. C. Haak
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - R. Vullings
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - S. G. Oei
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - S. A. B. Clur
- Department of Pediatric Cardiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - J. O. E. H. van Laar
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
- Eindhoven MedTech Innovation Center (e/MTIC), Eindhoven, The Netherlands
- Department of Pediatric Cardiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| |
Collapse
|
5
|
Evaluation of the Association between Fetal Cardiac Disorders with Choroid Plexus Cyst in Fetuses. J Cardiovasc Dev Dis 2022; 9:jcdd9020060. [PMID: 35200713 PMCID: PMC8880279 DOI: 10.3390/jcdd9020060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 01/18/2022] [Accepted: 02/10/2022] [Indexed: 11/17/2022] Open
Abstract
Choroid plexus cysts (CPCs) are often transient and benign findings observed in pregnancy screenings. This study aimed to examine the association between the frequency of congenital heart diseases and the detection of CPCs. In this prospective case-control study, pregnant mothers with no predisposing risk factors for the development of fetal cardiac abnormalities were eligible for entry. Based on the presence or absence of CPCs on ultrasound, the enrolled fetuses were divided into two groups. All patients (n = 100) underwent two-dimensional and color Doppler echocardiography to identify potential cardiac anomalies. Overall, CPCs were detected in 53 enrolled fetuses, and the remainder were enrolled as controls (n = 47). Pathological findings, such as echogenic intracardiac focus (EIF), ductal spasm, atrial septal defect (ASD), pericardial effusion, cardiomyopathy, and congenital heart disease were found in neither group. In the CPC group, two mild and six trivial cases of tricuspid regurgitation (TR) were detected. In the controls, five cases of trivial TR were identified. In conclusion, the presence of CPCs was not associated with significant functional or structural fetal cardiac abnormalities, which may be due to altered developmental mechanisms.
Collapse
|
6
|
Abstract
The possibility of pulse oximetry screening (POS) for congenital heart defects was first described over 20 years ago. Since then, an accumulation of research evidence and clinical practice experience has established POS as an important test to detect critical congenital heart defects (CCHDs). POS meets the criteria for universal screening and professional bodies around the globe have recommended universal POS. Many countries have already adopted POS while several others are working towards its implementation. In low and low-middle-income countries (LLMIC), POS has the additional potential for reducing morbidity and mortality from neonatal sepsis. This review summarises the evidence for POS and looks at current global uptake and different approaches to the implementation of POS.
Collapse
Affiliation(s)
- Asad Abbas
- Department of Neonatology, Birmingham Women's Hospital NHS Trust, Birmingham, United Kingdom.
| | - Andrew K Ewer
- Department of Neonatology, Birmingham Women's Hospital NHS Trust, Birmingham, United Kingdom; Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
7
|
Friedman P, Yilmaz A, Ugur Z, Jafar F, Whitten A, Ustun I, Turkoglu O, Graham S, Bahado Singh R. Urine metabolomic biomarkers for prediction of isolated fetal congenital heart defect. J Matern Fetal Neonatal Med 2021; 35:6380-6387. [PMID: 33944672 DOI: 10.1080/14767058.2021.1914572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To identify maternal second and third trimester urine metabolomic biomarkers for the detection of fetal congenital heart defects (CHDs). STUDY DESIGN This was a prospective study. Metabolomic analysis of randomly collected maternal urine was performed, comparing pregnancies with isolated, non-syndromic CHDs versus unaffected controls. Mass spectrometry (liquid chromatography and direct injection and tandem mass spectrometry, LC-MS-MS) as well as nuclear magnetic resonance spectrometry, 1H NMR, were used to perform the analyses between 14 0/7 and 37 0/7 weeks gestation. A total of 36 CHD cases and 41 controls were compared. Predictive algorithms using urine markers alone or combined with, clinical and ultrasound (US) (four-chamber view) predictors were developed and compared. RESULTS A total of 222 metabolites were identified, of which 16 were overlapping between the two platforms. Twenty-three metabolite concentrations were found in significantly altered in CHD gestations on univariate analysis. The concentration of methionine was most significantly altered. A predictive algorithm combining metabolites (histamine, choline, glucose, formate, methionine, and carnitine) plus US four-chamber view achieved an AUC = 0.894; 95% CI, 0814-0.973 with a sensitivity of 83.8% and specificity of 87.8%. Enrichment pathway analysis identified several lipid related pathways that are dysregulated in CHD, including phospholipid biosynthesis, phosphatidylcholine biosynthesis, phosphatidylethanolamine biosynthesis, and fatty acid metabolism. This could be consistent with the increased risk of CHD in diabetic pregnancies. CONCLUSIONS We report a novel, noninvasive approach, based on the analysis of maternal urine for isolated CHD detection. Further, the dysregulation of lipid- and folate metabolism appears to support prior data on the mechanism of CHD.
Collapse
Affiliation(s)
- Perry Friedman
- Division of Maternal Fetal Medicine, William Beaumont Health, Royal Oak, MI, USA
| | - Ali Yilmaz
- Division of Maternal Fetal Medicine, William Beaumont Health, Royal Oak, MI, USA
| | - Zafer Ugur
- Division of Maternal Fetal Medicine, William Beaumont Health, Royal Oak, MI, USA
| | - Faryal Jafar
- Division of Maternal Fetal Medicine, William Beaumont Health, Royal Oak, MI, USA
| | - Amy Whitten
- Division of Maternal Fetal Medicine, William Beaumont Health, Royal Oak, MI, USA
| | - Ilyas Ustun
- Center for Data Science,DePaul University School of Computing, Chicago, IL, USA
| | - Onur Turkoglu
- Division of Maternal Fetal Medicine, William Beaumont Health, Royal Oak, MI, USA
| | - Stewart Graham
- Division of Maternal Fetal Medicine, William Beaumont Health, Royal Oak, MI, USA
| | - Ray Bahado Singh
- Division of Maternal Fetal Medicine, William Beaumont Health, Royal Oak, MI, USA
| |
Collapse
|
8
|
Abstract
BACKGROUND Medical advancements have encouraged minimally invasive surgical repair of congenital heart defects such as ventricular septal defects (VSDs), and the diagnostic process can now be carried out using non-traditional techniques such as pulse oximetry. This, in turn, has improved clinical outcomes with reduced complication rates post-surgery. However, the variations in type of VSDs, age of patient, comorbidities, and access to closure devices may limit the efficacy of surgical advancements. METHODS Articles were identified amongst Scopus, MEDLINE, and PubMed using various relevant search strings using PRISMA guidelines. Of the 115 articles initially extracted, 10 were eventually reviewed after duplicates and irrelevant studies were removed. RESULTS Of the 24 eligible articles, 10 papers were selected for analysis. Minimally invasive approaches to VSD repair was associated with satisfactory short-term outcomes when compared to open repair. For diagnosis of congenital VSD, whilst recent advances such as pulse oximetry method and genome analysis are more sensitive, the limited availability and access to such investigatory methods must be recognised. CONCLUSION Pulse oximetry and fetal echocardiography are established non-invasive diagnostic tools for VSD. The recent advances in minimally invasive treatment options including periventricular approach and transcatheter techniques have improved patient outcomes, yet at the expense of higher residual rates. Careful patient selection for each technique and follow-up should be planned through multidisciplinary team meetings.
Collapse
|
9
|
Troisi J, Cavallo P, Richards S, Symes S, Colucci A, Sarno L, Landolfi A, Scala G, Adair D, Ciccone C, Maruotti GM, Martinelli P, Guida M. Noninvasive screening for congenital heart defects using a serum metabolomics approach. Prenat Diagn 2021; 41:743-753. [PMID: 33440021 DOI: 10.1002/pd.5893] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/11/2020] [Accepted: 12/20/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Heart anomalies represent nearly one-third of all congenital anomalies. They are currently diagnosed using ultrasound. However, there is a strong need for a more accurate and less operator-dependent screening method. Here we report a metabolomics characterization of maternal serum in order to describe a metabolomic fingerprint representative of heart congenital anomalies. METHODS Metabolomic profiles were obtained from serum of 350 mothers (280 controls and 70 cases). Nine classification models were built and optimized. An ensemble model was built based on the results from the individual models. RESULTS The ensemble machine learning model correctly classified all cases and controls. Malonic, 3-hydroxybutyric and methyl glutaric acid, urea, androstenedione, fructose, tocopherol, leucine, and putrescine were determined as the most relevant metabolites in class separation. CONCLUSION The metabolomic signature of second trimester maternal serum from pregnancies affected by a fetal heart anomaly is quantifiably different from that of a normal pregnancy. Maternal serum metabolomics is a promising tool for the accurate and sensitive screening of such congenital defects. Moreover, the revelation of the associated metabolites and their respective biochemical pathways allows a better understanding of the overall pathophysiology of affected pregnancies.
Collapse
Affiliation(s)
- Jacopo Troisi
- Department of Medicine and Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy.,Metabolomics section, Theoreo Srl - Spin-off Company of the University of Salerno, Salerno, Italy.,Metabolomics section, European Biomedical Research Institute of Salerno (EBRIS), Salerno, Italy
| | - Pierpaolo Cavallo
- Department of Physics, University of Salerno, Salerno, Italy.,Istituto Sistemi Complessi, Consiglio Nazionale delle Ricerche (CNR), Rome, Italy
| | - Sean Richards
- Department of Biology, Geology and Environmental Sciences, University of Tennessee at Chattanooga, Chattanooga, Tennessee, USA.,Department of Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, TN, USA
| | - Steven Symes
- Department of Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, TN, USA.,Department of Chemistry and Physics, University of Tennessee at Chattanooga, Chattanooga, Tennessee, USA
| | - Angelo Colucci
- Department of Medicine and Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Laura Sarno
- Department of Neurosciences and Reproductive and Dentistry Sciences, University of Naples Federico II, Naples, Italy
| | - Annamaria Landolfi
- Department of Medicine and Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Giovanni Scala
- Metabolomics section, Theoreo Srl - Spin-off Company of the University of Salerno, Salerno, Italy.,Hosmotic Srl, Naples, Italy
| | - David Adair
- Department of Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, TN, USA
| | - Carla Ciccone
- Obstetrics and Gynecology clinic, G. Moscati Hospital, Avellino, Italy
| | - Giuseppe M Maruotti
- Department of Neurosciences and Reproductive and Dentistry Sciences, University of Naples Federico II, Naples, Italy
| | - Pasquale Martinelli
- Department of Neurosciences and Reproductive and Dentistry Sciences, University of Naples Federico II, Naples, Italy
| | - Maurizio Guida
- Department of Medicine and Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy.,Metabolomics section, Theoreo Srl - Spin-off Company of the University of Salerno, Salerno, Italy.,Department of Neurosciences and Reproductive and Dentistry Sciences, University of Naples Federico II, Naples, Italy
| |
Collapse
|
10
|
Mukerji A, Shafey A, Jain A, Cohen E, Shah PS, Sander B, Shah V. Pulse oximetry screening for critical congenital heart defects in Ontario, Canada: a cost-effectiveness analysis. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2020; 111:804-811. [PMID: 31907759 PMCID: PMC7501328 DOI: 10.17269/s41997-019-00280-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 12/03/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Previously conducted cost-effectiveness analyses of pulse oximetry screening (POS) for critical congenital heart defects (CCHDs) have shown it to be a cost-effective endeavour, but the geographical setting of Ontario in relation to its vast yet sparsely populated regions presents unique challenges. The objective of this study was to estimate the cost-effectiveness of POS for CCHD in Ontario, Canada. METHODS A cost-effectiveness analysis, comparing POS to no POS, was conducted from the Ontario healthcare payer perspective using a Markov model. The base case was defined as a well-appearing newborn at 24 h of age. Outcome measures, including quality-adjusted life months (QALMs), lifetime costs, and incremental cost-effectiveness ratios (ICER) [ΔCost/ΔQALMs], were calculated over a lifetime horizon. All outcomes were discounted at 1.5% per year. Cost-effectiveness was assessed using an a priori ICER threshold of CAD$4166.67 per QALM (equivalent to CAD$50,000 per quality-adjusted life year). Deterministic and probabilistic sensitivity analyses were conducted to assess parameter uncertainty. RESULTS Implementation of POS is expected to lead to timely diagnosis of 51 CCHD cases annually. The incremental cost of performing POS was estimated to be $27.27 per screened individual, with a gain of 0.02455 QALMs. This yielded an ICER of CAD$1110.79 per QALM, well below the pre-determined threshold. The probabilistic sensitivity analysis estimated a 92.3% chance of routine implementation of POS being cost-effective. CONCLUSION Routine implementation of POS for CCHD in Ontario is expected to be cost-effective.
Collapse
Affiliation(s)
- Amit Mukerji
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
| | - Amy Shafey
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Amish Jain
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Eyal Cohen
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Prakesh S Shah
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Vibhuti Shah
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
11
|
Ngeow AJH, Tan MG, Choo JTL, Tan TH, Tan WC, Chan DKL. Screening for congenital heart disease in a Singapore neonatal unit. Singapore Med J 2019; 62:341-346. [PMID: 31820009 DOI: 10.11622/smedj.2019167] [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: 11/18/2022]
Abstract
INTRODUCTION Congenital heart disease (CHD) is a leading cause of infant mortality. The aim of this study was to evaluate the efficacy of a neonatal screening programme for CHD before the introduction of pulse oximetry. METHODS This was a retrospective review of live births in the period 2003-2012. Cases of CHD were detected through prenatal ultrasonography and/or postnatal examination, and confirmed using two-dimensional echocardiography. Data was rigorously checked against multiple sources. The antenatal detection rate, sensitivity, specificity, predictive values and likelihood ratios of the screening programme were analysed for all cases of CHD and critical CHD. RESULTS The incidence of CHD was 9.7 per 1,000 live births. The commonest CHD was ventricular septal defect (54.8%). The antenatal detection rate was three times higher in the critical CHD group (64.0%) compared to the group as a whole (21.1%). The sensitivity and specificity of screening was 64.5% and 99.7% for all CHD, and 92.9% and 99.1% for the critical CHD group, respectively. The positive likelihood ratio was 215 and 103, while the negative likelihood ratio was 0.36 and 0.07 for all CHD and critical CHD, respectively. CONCLUSION The CHD screening programme had excellent specificity but limited sensitivity. The high positive likelihood ratios indicate that where sufficient risk factors for CHD are present, a positive result effectively confirms the presence of CHD. The low negative likelihood ratio for critical CHD indicates that, where prior suspicion for critical CHD is low, a negative result is reassuring.
Collapse
Affiliation(s)
- Alvin Jia-Hao Ngeow
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - Mary Grace Tan
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - Jonathan Tze-Liang Choo
- Cardiology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore
| | - Teng-Hong Tan
- Cardiology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore
| | - Wei Ching Tan
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
| | - Daisy Kwai-Lin Chan
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| |
Collapse
|
12
|
Sahin-Uysal N, Gulumser C, Kocaman E, Varan B, Bayraktar N, Yanık F. Maternal and cord blood homocysteine, vitamin B12, folate, and B-type natriuretic peptide levels at term for predicting congenital heart disease of the neonate: A case-control study. J Matern Fetal Neonatal Med 2019; 33:2649-2656. [PMID: 31256695 DOI: 10.1080/14767058.2019.1633300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To investigate the effectiveness of the metabolic markers homocysteine, vitamin B12, folate, and B-type natriuretic peptide in maternal and cord blood for detecting congenital heart disease.Methods: Homocysteine, vitamin B12, folate, and B-type natriuretic peptide concentrations in maternal and cord blood samples at term were measured in the case (n = 42) and control (n = 43) groups with and without fetal congenital heart disease, respectively. Additionally, newborns with congenital heart disease were divided into two subgroups: those with (n = 30) and without (n = 8) 6-month infant survival. The case and control groups and case subgroups were compared with each other with respect to maternal age, gravidity, parity, gestational age at delivery, birth weight, maternal and cord blood levels of homocysteine, vitamin B12, folate, and B-type natriuretic peptide, and arterial cord blood pH and base excess values. Statistical analyses were performed using SPSS for Windows, version 22.0. The Student's t-test, the Mann-Whitney U test, and the χ2 test were used where appropriate. A p value of < .05 was considered statistically significant.Results: Mean maternal age, birth weight and median gravidity, parity and gestational age at delivery were not significantly different between the case and control groups, as well as between the case subgroups (all p > .05). Concentrations of metabolic markers in maternal blood were not significantly different between the two groups (p > .05). Homocysteine and B-type natriuretic peptide levels in cord blood samples were significantly higher, whereas folate levels were significantly lower in the case group compared with the control group (all p < .05). Cord blood B-type natriuretic peptide levels were significantly higher (p < .05) and arterial cord blood pH values were significantly lower (p < .05) in the case subgroup without 6-month infant survival compared with the case subgroup with 6-month infant survival.Conclusion: High cord blood B-type natriuretic peptide and homocysteine levels and low cord blood folate levels at term may be useful for predicting congenital heart disease in the neonate. Neonates with congenital heart disease who have high cord blood B-type natriuretic peptide and low pH values may have adverse outcomes.
Collapse
Affiliation(s)
- Nihal Sahin-Uysal
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Cagri Gulumser
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Eda Kocaman
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Birgül Varan
- Department of Pediatric Cardiology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Nilüfer Bayraktar
- Department of Medical Biochemistry, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Filiz Yanık
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
13
|
Noben L, Clur SA, van Laar JO, Vullings R. Prenatal diagnosis of a bundle branch block based on the fetal ECG. BMJ Case Rep 2019; 12:12/7/e229998. [PMID: 31266761 DOI: 10.1136/bcr-2019-229998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A non-invasive fetal ECG was performed on a 36-year-old pregnant woman at 24+6 weeks of gestation as part of ongoing clinical research. A paediatric cardiologist suspected an incomplete bundle branch block based on the averaged ECGs from the recording. The characteristic terminal R' wave was present in multiple leads of the fetal ECGs. A fetal anomaly scan had been performed at 20 weeks of gestation and showed no abnormalities. An incomplete right bundle branch block was confirmed on an ECG recorded at the age of 2 years. This case shows the possibility of novel non-invasive fetal ECG technology as an adjunct to the diagnosis of fetal cardiac anomalies in the future.
Collapse
Affiliation(s)
- Lore Noben
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Sally-Ann Clur
- Department of Pediatric Cardiology, Emma Children's Hospital AMC, Amsterdam, The Netherlands
| | - Judith Oeh van Laar
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Rik Vullings
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| |
Collapse
|
14
|
Jivanji SGM, Lubega S, Reel B, Qureshi SA. Congenital Heart Disease in East Africa. Front Pediatr 2019; 7:250. [PMID: 31294003 PMCID: PMC6606724 DOI: 10.3389/fped.2019.00250] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/31/2019] [Indexed: 11/13/2022] Open
Abstract
Congenital Heart Disease (CHD) is an enormous problem in Low Middle Income Countries and particularly in sub-Saharan Africa. There is an estimated 500,000 children born in Africa with CHD each year with a major proportion of this in sub-Saharan Africa. The vast majority of these children receive sub-optimal or no care at all. In East Africa: Kenya, Tanzania, and Uganda have all attempted to create a CHD service for the last 20 years with minimal success due to various factors. Visiting cardiac missions have made considerable contributions in the development of CHD services in these countries, however there remains a significant number of children with lack of care. We explore the positive aspects of the current projects, the various factors that hinder growth in this area, and what can be done to promote CHD service growth in these countries.
Collapse
Affiliation(s)
- Salim G. M. Jivanji
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Sulaiman Lubega
- Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Bhupi Reel
- Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Shakeel A. Qureshi
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
15
|
Greaney D, Honjo O, O'Leary JD. The single ventricle pathway in paediatrics for anaesthetists. BJA Educ 2019; 19:144-150. [PMID: 33456883 DOI: 10.1016/j.bjae.2019.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2019] [Indexed: 10/27/2022] Open
Affiliation(s)
- D Greaney
- The Hospital for Sick Children, Toronto, ON, Canada
| | - O Honjo
- The Hospital for Sick Children, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - J D O'Leary
- The Hospital for Sick Children, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| |
Collapse
|
16
|
Westphal DS, Leszinski GS, Rieger‐Fackeldey E, Graf E, Weirich G, Meitinger T, Ostermayer E, Oberhoffer R, Wagner M. Lessons from exome sequencing in prenatally diagnosed heart defects: A basis for prenatal testing. Clin Genet 2019; 95:582-589. [DOI: 10.1111/cge.13536] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/07/2019] [Accepted: 03/12/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Dominik S. Westphal
- Institute of Human GeneticsTechnical University of Munich Munich Germany
- Institute of Human GeneticsHelmholtz Zentrum Munich Neuherberg Germany
| | | | | | - Elisabeth Graf
- Institute of Human GeneticsHelmholtz Zentrum Munich Neuherberg Germany
| | - Gregor Weirich
- Institute of PathologyTechnical University of Munich Munich Germany
| | - Thomas Meitinger
- Institute of Human GeneticsTechnical University of Munich Munich Germany
- Institute of Human GeneticsHelmholtz Zentrum Munich Neuherberg Germany
| | - Eva Ostermayer
- Department of Gynecology and ObstetricsTechnical University of Munich Munich Germany
| | - Renate Oberhoffer
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum MünchenTechnical University of Munich Munich Germany
| | - Matias Wagner
- Institute of Human GeneticsTechnical University of Munich Munich Germany
- Institute of NeurogenomicsHelmholtz Zentrum Munich Neuherberg Germany
| |
Collapse
|
17
|
|
18
|
Reid A, Gaskin K. Parents' experiences of receiving an antenatal versus postnatal diagnosis of complex congenital heart disease. Nurs Child Young People 2018; 30:19-25. [PMID: 30358337 DOI: 10.7748/ncyp.2018.e1078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND The time point at which parents receive a diagnosis of congenital heart disease (CHD) has changed over the years due in part to advances in fetal ultrasound. However, CHD remains undiscovered until after birth in some cases. The psychological effect of time of diagnosis on parents' experiences has not been well researched. AIM To explore parents' experiences at the time of diagnosis of complex CHD and to compare if experiences differ when receiving an antenatal versus postnatal diagnosis. METHOD Descriptive and thematic analysis of primary mixed qualitative and quantitative data, collected in 2012-2013, from an online survey of parents ( n =22) whose infants had undergone stage one surgery for a functionally univentricular heart. FINDINGS Four themes emerged: parents' understanding of the condition at the time of diagnosis; parents' emotions at the time of diagnosis; sources of support at the time of diagnosis; and additional sources of information after the diagnosis. CONCLUSION There are implications for practice in terms of who provides the diagnosis and, more importantly, how well it is explained. Professionals need to assess parents' emotional status, information needs and level of understanding irrespective of time of diagnosis, so that support is individualised, sensitive and time appropriate.
Collapse
Affiliation(s)
- Annette Reid
- Children's ward, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, England
| | - Kerry Gaskin
- Advanced clinical practice, Department of Nursing and Midwifery, Institute of Health and Society, University of Worcester, Worcester, England
| |
Collapse
|
19
|
Trends and Outcomes After Prenatal Diagnosis of Congenital Cardiac Defects: Experience of a Dedicated Fetal Medicine Centre from South India. JOURNAL OF FETAL MEDICINE 2018. [DOI: 10.1007/s40556-018-0186-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
20
|
Hunter LE, Seale AN. EDUCATIONAL SERIES IN CONGENITAL HEART DISEASE: Prenatal diagnosis of congenital heart disease. Echo Res Pract 2018; 5:R81-R100. [PMID: 30012852 PMCID: PMC6107762 DOI: 10.1530/erp-18-0027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/16/2018] [Indexed: 12/31/2022] Open
Abstract
This review article will guide the reader through the background of prenatal screening for congenital heart disease. The reader will be given insight into the normal screening views, common abnormalities, risk stratification of lesions and also recent advances in prenatal cardiology.
Collapse
Affiliation(s)
- Lindsey E Hunter
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, UK
| | - Anna N Seale
- Department of Paediatric Cardiology, Birmingham Children’s Hospital, Birmingham, UK
| |
Collapse
|
21
|
Singh Y, Mikrou P. Use of prostaglandins in duct-dependent congenital heart conditions. Arch Dis Child Educ Pract Ed 2018; 103:137-140. [PMID: 29162633 DOI: 10.1136/archdischild-2017-313654] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/03/2017] [Accepted: 10/09/2017] [Indexed: 11/03/2022]
Abstract
Congenital heart disease (CHD) remains a leading cause of infant mortality, which is even higher in infants with undiagnosed duct-dependent CHDs. Up to 39%-50% of infants with critical CHD are being discharged undiagnosed from the hospital. Infants with duct-dependent critical CHD remain well during the fetal period and may deteriorate when the ductus arteriosus (commonly called 'duct') closes after birth. It is critical to open or maintain ductus arteriosus patent in infants with duct-dependent CHDs. Prostaglandin E1 (alprostadil marketed as 'Prostin VR ') and prostaglandin E2 (dinoprostone) are used to maintain a patent ductus arteriosus and the dose of medication depends on the clinical presentation. Delay in starting prostaglandin infusion can have deleterious effects on infants and can even lead to death. These infants often present as an emergency, and professionals caring for these infants need to have a good understanding of these conditions and medications used for ductal patency.
Collapse
Affiliation(s)
- Yogen Singh
- Department of Neonatology and Paediatric Cardiology, Cambridge University Hospitals NHS Foundation Trust and University of Cambridge, Cambridge, UK
| | | |
Collapse
|
22
|
Edwards H, Hamilton R. Single centre audit of early impact of inclusion of the three vessel and trachea view in obstetric screening. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2018; 26:93-100. [PMID: 30013609 DOI: 10.1177/1742271x17749718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 11/23/2017] [Indexed: 11/15/2022]
Abstract
Detection rates of congenital cardiac malformations have traditionally remained low. The NHS Fetal Anomaly Screening Programme (FASP) aims to increase these detection rates for various reasons, including influencing perinatal management and aiding parental decision making. The inclusion of the three vessel view and trachea (3VT) view in 2015 aimed to improve detection rates of arch abnormalities in particular. This study evaluated the early impact of the new initiative at one NHS Trust. Departmental screen-positive rates were compared for a full year before and after implementation. Referrals to, and opinions of, the foetal medicine unit (FMU) were assessed; as were undetected congenital heart defects for the two time periods. Compared with the pre-implementation (pre-3VT) period, the number of completed anomaly scans performed after implementation (post-3VT) increased by 3% and the number of FMU referrals increased by 625%. Departmental screen-positive rates for cardiac abnormalities increased from 40% (pre-3VT) to 91% (post-3VT). Over half (52%) of the FMU referrals were made due to a suspected abnormal 3VT view. Early evaluation of 3VT implementation at this NHS Trust indicates that it has been a success. Departmental screen-positive rates for congenital cardiac malformations have risen. However, this performance has come at a cost: Some abnormalities now being detected, such as loose vascular ring and PLSVC, are frequently asymptomatic and likely to be clinically insignificant. The implementation of 3VT achieves the aims of FASP but may begin to exceed what is expected from a low risk population screening programme.
Collapse
|
23
|
van Velzen CL, Ket JCF, van de Ven PM, Blom NA, Haak MC. Systematic review and meta-analysis of the performance of second-trimester screening for prenatal detection of congenital heart defects. Int J Gynaecol Obstet 2017; 140:137-145. [PMID: 29094357 DOI: 10.1002/ijgo.12373] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/11/2017] [Accepted: 10/31/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND The prenatal detection rate of congenital heart defects (CHDs) is increasing, but reported rates vary. OBJECTIVES To determine the performance of the second-trimester anomaly scan to detect CHD. SEARCH STRATEGY PubMed and Embase were searched for relevant studies in any language from inception to February 3, 2017. The search terms included "prenatal diagnosis" or "pregnancy," "cardiovascular diseases" or "cardiac defects," "congenital," and "specificity," or "sensitivity," or "cohort study." SELECTION CRITERIA Cohort studies assessing the detection rate of CHD during population-based prenatal screening from 1995 were eligible for inclusion. DATA COLLECTION AND ANALYSIS Data were collected from identified studies; authors were approached for additional data when necessary. A review and meta-analysis were performed. When possible, separate analyses were undertaken for isolated CHD cases. MAIN RESULTS Meta-analysis of seven studies showed the pooled detection rate of CHD in unselected populations as 45.1% (95% confidence interval 33.5%-57.0%). However, the rate of detection of univentricular defects and heterotaxy was above 85%. Similar rates were found among cases of isolated CHD. CONCLUSIONS Prenatal detection showed a strong correlation with CHD severity. The detection of conotruncal anomalies needs to improve. A thoroughly organized screening program will be essential to achieve a higher detection rate.
Collapse
Affiliation(s)
- Christine L van Velzen
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, Netherlands
| | | | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Nico A Blom
- Department of Pediatric Cardiology, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands.,Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Monique C Haak
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, Netherlands
| |
Collapse
|
24
|
Changes in the diagnosis of congenital cardiovascular malformations during the 1st year of life: impacts on epidemiological risk factor associations. Cardiol Young 2017; 27:770-781. [PMID: 28462756 DOI: 10.1017/s104795111600130x] [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] [Indexed: 11/05/2022]
Abstract
Many epidemiological studies base their classification of congenital cardiovascular malformations in newborns upon a single, initial diagnosis. This study aimed to evaluate the effect of subsequent diagnostic investigations on the results of epidemiological studies. We used diagnostic codes from the Baltimore-Washington Infant Study from the time of birth and at ~1 year of age. Odds ratios and 95% confidence intervals were used to identify associations between changes in diagnoses and infant characteristics, time period, that is, before and after introduction of color flow Doppler imaging, and diagnostic variables. Of the 3054 patients with data at both time points, 400 (13.1%) had diagnostic changes. For congenital cardiovascular malformations of early cardiogenesis, such as laterality and looping defects, conotruncal malformations, and atrioventricular septal defects, significant associations were observed between diagnostic change and case infants large for gestational age (odds ratio=0.22, p=0.01), diagnosed initially by echocardiography only (odds ratio=2.05, p=0.001), or with non-cardiac malformations (odds ratio=0.60, p=0.03). For all other congenital cardiovascular malformations, significant associations were observed with echocardiography-only diagnosis (odds ratio=1.43, p=0.04) and non-cardiac malformations (odds ratio=0.57, p<0.001). We found no statistically significant differences between risk factor odds ratios calculated using initial diagnoses versus those calculated using 1-year update diagnoses. Changes in congenital cardiovascular malformation diagnoses from birth to year 1 interval were significantly associated with infant characteristics and diagnostic modality but did not materially affect the outcome of risk factor associations.
Collapse
|
25
|
Three- and four-dimensional ultrasound in fetal echocardiography: an up-to-date overview. J Perinatol 2016; 36:685-93. [PMID: 26963426 DOI: 10.1038/jp.2016.23] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 01/04/2016] [Accepted: 01/15/2016] [Indexed: 12/13/2022]
Abstract
Congenital heart diseases (CHD) are the most commonly overlooked lesions in prenatal screening programs. Real-time two-dimensional ultrasound (2DUS) is the conventionally used tool for fetal echocardiography. Although continuous improvements in the hardware and post-processing software have resulted in a good image quality even in late first trimester, 2DUS still has its limitations. Four-dimensional ultrasound with spatiotemporal image correlation (STIC) is an automated volume acquisition, recording a single three-dimensional (3D) volume throughout a complete cardiac cycle, which results in a four-dimensional (4D) volume. STIC has the potential to increase the detection rate of CHD. The aim of this study is to provide a practical overview of the possibilities and (dis)advantages of STIC. A review of literature and evaluation of the current status and clinical value of 3D/4D ultrasound in prenatal screening and diagnosis of congenital heart disease are presented.
Collapse
|
26
|
van Velzen CL, Clur SA, Rijlaarsdam MEB, Pajkrt E, Bax CJ, Hruda J, de Groot CJM, Blom NA, Haak MC. Prenatal diagnosis of congenital heart defects: accuracy and discrepancies in a multicenter cohort. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:616-622. [PMID: 26350159 DOI: 10.1002/uog.15742] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 08/05/2015] [Accepted: 09/03/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To examine the accuracy of fetal echocardiography in diagnosing congenital heart disease (CHD) at the fetal medicine units of three tertiary care centers. METHODS This was a multicenter cohort study of tertiary echocardiography referrals between 2002 and 2012. Prenatal and postnatal diagnoses were compared and the degree of agreement was classified as 'correct' (anatomy correct and the postnatal diagnosis led to a similar outcome as expected), 'discrepant' (anatomical discrepancies present but the severity and prognosis of the defect were diagnosed correctly) or 'no similarity' (the pre- and postnatal diagnoses differed completely). RESULTS We included 708 cases with CHD for which both prenatal and postnatal data were available. The prenatal diagnosis was correct in 82.1% of cases and discrepancies present were present in 9.9%; however, these did not result in a different outcome. In 8.1% there was no similarity between prenatal and postnatal diagnoses. Disagreement between pre- and postnatal diagnoses occurred significantly more frequently in cases that presented with a normal four-chamber view than in those with an abnormal four-chamber view (5.5% vs 1.9%). Incorrect identification of the outflow tracts and incorrect differentiation between unbalanced atrioventricular septal defect and hypoplastic left heart syndrome were relatively commonly encountered. In many cases with disagreement, trisomy 21, extracardiac anomaly or a high maternal body mass index was present. CONCLUSIONS The prenatal diagnosis and estimated prognosis of fetal echocardiography in our tertiary referral centers were appropriate in 92% of cases. Some types of CHD remain difficult to diagnose or rule-out prenatally, therefore awareness and education are of considerable importance. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- C L van Velzen
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - S A Clur
- Department of Pediatric Cardiology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - M E B Rijlaarsdam
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - E Pajkrt
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - C J Bax
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - J Hruda
- Department of Pediatric Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - C J M de Groot
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - N A Blom
- Department of Pediatric Cardiology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M C Haak
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
27
|
Yang L, Pei QY, Li YT, Yang ZJ. The Application of an Anatomical Database for Fetal Congenital Heart Disease. Chin Med J (Engl) 2016; 128:2583-7. [PMID: 26415794 PMCID: PMC4736863 DOI: 10.4103/0366-6999.166045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Fetal congenital heart anomalies are the most common congenital anomalies in live births. Fetal echocardiography (FECG) is the only prenatal diagnostic approach used to detect fetal congenital heart disease (CHD). FECG is not widely used, and the antenatal diagnosis rate of CHD varies considerably. Thus, mastering the anatomical characteristics of different kinds of CHD is critical for ultrasound physicians to improve FECG technology. The aim of this study is to investigate the applications of a fetal CHD anatomic database in FECG teaching and training program. Methods: We evaluated 60 transverse section databases including 27 types of fetal CHD built in the Prenatal Diagnosis Center in Peking University People's Hospital. Each original database contained 400–700 cross-sectional digital images with a resolution of 3744 pixels × 5616 pixels. We imported the database into Amira 5.3.1 (Australia Visage Imaging Company, Australia) three-dimensional (3D) software. The database functions use a series of 3D software visual operations. The features of the fetal CHD anatomical database were analyzed to determine its applications in FECG continuing education and training. Results: The database was rebuilt using the 3D software. The original and rebuilt databases can be displayed dynamically, continuously, and synchronically and can be rotated at arbitrary angles. The sections from the dynamic displays and rotating angles are consistent with the sections in FECG. The database successfully reproduced the anatomic structures and spatial relationship features of different fetal CHDs. We established a fetal CHD anatomy training database and a standardized training database for FECG. Ultrasound physicians and students can learn the anatomical features of fetal CHD and FECG through either centralized training or distance education. Conclusions: The database of fetal CHD successfully reproduced the anatomic structures and spatial relationship of different kinds of fetal CHD. This database can be widely used in anatomy and FECG teaching and training.
Collapse
Affiliation(s)
| | - Qiu-Yan Pei
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | | | | |
Collapse
|
28
|
Zhu X, Li J, Ru T, Wang Y, Xu Y, Yang Y, Wu X, Cram DS, Hu Y. Identification of copy number variations associated with congenital heart disease by chromosomal microarray analysis and next-generation sequencing. Prenat Diagn 2016; 36:321-7. [PMID: 26833920 DOI: 10.1002/pd.4782] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 01/23/2016] [Accepted: 01/28/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine the type and frequency of pathogenic chromosomal abnormalities in fetuses diagnosed with congenital heart disease (CHD) using chromosomal microarray analysis (CMA) and validate next-generation sequencing as an alternative diagnostic method. METHOD Chromosomal aneuploidies and submicroscopic copy number variations (CNVs) were identified in amniocytes DNA samples from CHD fetuses using high-resolution CMA and copy number variation sequencing (CNV-Seq). RESULT Overall, 21 of 115 CHD fetuses (18.3%) referred for CMA had a pathogenic chromosomal anomaly. In six of 73 fetuses (8.2%) with an isolated CHD, CMA identified two cases of DiGeorge syndrome, and one case each of 1q21.1 microdeletion, 16p11.2 microdeletion and Angelman/Prader Willi syndromes, and 22q11.21 microduplication syndrome. In 12 of 42 fetuses (28.6%) with CHD and additional structural abnormalities, CMA identified eight whole or partial trisomies (19.0%), five CNVs (11.9%) associated with DiGeorge, Wolf-Hirschhorn, Miller-Dieker, Cri du Chat and Blepharophimosis, Ptosis, and Epicanthus Inversus syndromes and four other rare pathogenic CNVs (9.5%). Overall, there was a 100% diagnostic concordance between CMA and CNV-Seq for detecting all 21 pathogenic chromosomal abnormalities associated with CHD. CONCLUSION CMA and CNV-Seq are reliable and accurate prenatal techniques for identifying pathogenic fetal chromosomal abnormalities associated with cardiac defects. © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Xiangyu Zhu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jie Li
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Tong Ru
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yaping Wang
- Department of Medical Genetics of Nanjing University Medical School, Nanjing, China
| | - Yan Xu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ying Yang
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xing Wu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | | | - Yali Hu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| |
Collapse
|
29
|
Bahado-Singh RO, Zaffra R, Albayarak S, Chelliah A, Bolinjkar R, Turkoglu O, Radhakrishna U. Epigenetic markers for newborn congenital heart defect (CHD). J Matern Fetal Neonatal Med 2015; 29:1881-7. [PMID: 26429603 DOI: 10.3109/14767058.2015.1069811] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Our objective was to determine whether there were significant differences in genome-wide DNA methylation in newborns with major congenital heart defect (CHD) compared to controls. We also evaluated methylation of cytosines in CpG motifs for the detection of these CHDs. METHODS Genome-wide DNA methylation analysis was performed on DNA from 60 newborns with various CHDs, including hypoplastic left heart syndrome, ventricular septal deficit, atrial septal defect, pulmonary stenosis, coarctation of the aorta and Tetralogy of Fallot, and 32 controls. RESULTS Highly significant differences in cytosine methylation were seen in a large number of genes throughout the genome for all CHD categories. Gene ontology analysis of CHD overall indicated over-represented biological processes involving cell development and differentiation, and anatomical structure morphogenesis. Methylation of individual cytosines in CpG motifs had high diagnostic accuracy for the detection of CHD. For example, for coarctation one predictive model based on levels of particular cytosine nucleotides achieved a sensitivity of 100% and specificity of 93.8% (AUC = 0.974, p < 0.00001). CONCLUSION Profound differences in cytosine methylation were observed in hundreds of genes in newborns with different types of CHD. There appears to be the potential for development of accurate genetic biomarkers for CHD detection in newborns.
Collapse
Affiliation(s)
- Ray O Bahado-Singh
- a Department of Obstetrics and Gynecology , William Beaumont School of Medicine, Oakland University , Royal Oak , MI , USA and
| | - Rita Zaffra
- b Department of Obstetrics and Gynecology , Wayne State University School of Medicine , Detroit , MI , USA
| | - Samet Albayarak
- b Department of Obstetrics and Gynecology , Wayne State University School of Medicine , Detroit , MI , USA
| | - Anushka Chelliah
- b Department of Obstetrics and Gynecology , Wayne State University School of Medicine , Detroit , MI , USA
| | - Rashmi Bolinjkar
- b Department of Obstetrics and Gynecology , Wayne State University School of Medicine , Detroit , MI , USA
| | - Onur Turkoglu
- a Department of Obstetrics and Gynecology , William Beaumont School of Medicine, Oakland University , Royal Oak , MI , USA and
| | - Uppala Radhakrishna
- a Department of Obstetrics and Gynecology , William Beaumont School of Medicine, Oakland University , Royal Oak , MI , USA and
| |
Collapse
|
30
|
Establishment of a database of fetal congenital heart malformations and preliminary investigation of its clinical application. Taiwan J Obstet Gynecol 2015; 54:284-9. [DOI: 10.1016/j.tjog.2015.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2015] [Indexed: 10/23/2022] Open
|
31
|
van Velzen CL, Clur SA, Rijlaarsdam MEB, Bax CJ, Pajkrt E, Heymans MW, Bekker MN, Hruda J, de Groot CJM, Blom NA, Haak MC. Prenatal detection of congenital heart disease--results of a national screening programme. BJOG 2015; 123:400-7. [PMID: 25625301 DOI: 10.1111/1471-0528.13274] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Congenital heart disease (CHD) is the most common congenital malformation and causes major morbidity and mortality. Prenatal detection improves the neonatal condition before surgery, resulting in less morbidity and mortality. In the Netherlands a national prenatal screening programme was introduced in 2007. This study evaluates the effects of this screening programme. DESIGN Geographical cohort study. SETTING Large referral region of three tertiary care centres. POPULATION Fetuses and infants diagnosed with severe CHD born between 1 January 2002 and 1 January 2012. METHODS Cases were divided into two groups: before and after the introduction of screening. MAIN OUTCOME MEASURES Detection rates were calculated. RESULTS The prenatal detection rate (n = 1912) increased with 23.9% (95% confidence interval [95% CI] 19.5-28.3) from 35.8 to 59.7% after the introduction of screening and of isolated CHD with 21.4% (95% CI 16.0-26.8) from 22.8 to 44.2%. The highest detection rates were found in the hypoplastic left heart syndrome, other univentricular defects and complex defects with atrial isomerism (>93%). Since the introduction of screening, the 'late' referrals (after 24 weeks of gestation) decreased by 24.3% (95% CI 19.3-29.3). CONCLUSIONS This is the largest cohort study to investigate the prenatal detection rate of severe CHD in an unselected population. A nationally organised screening has resulted in a remarkably high detection rate of CHD (59.7%) compared with earlier literature.
Collapse
Affiliation(s)
- C L van Velzen
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands
| | - S A Clur
- Department of Pediatric Cardiology, Academic Medical Centre, Emma Children's Hospital, Amsterdam, the Netherlands
| | - M E B Rijlaarsdam
- Department of Paediatric Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - C J Bax
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands
| | - E Pajkrt
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands
| | - M W Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands
| | - M N Bekker
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - J Hruda
- Department of Paediatric Cardiology, VU University Medical Centre, Amsterdam, the Netherlands
| | - C J M de Groot
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands
| | - N A Blom
- Department of Pediatric Cardiology, Academic Medical Centre, Emma Children's Hospital, Amsterdam, the Netherlands.,Department of Paediatric Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - M C Haak
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
| |
Collapse
|
32
|
Araujo Júnior E, Darahem Tedesco G, Carvalho Carrilho M, Borges Peixoto A, Costa Carvalho FH. 4D Fetal Echocardiography in Clinical Practice. ACTA ACUST UNITED AC 2015. [DOI: 10.5005/jp-journals-10009-1425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Spatiotemporal image correlation (STIC) is a technique that acquires the fetal cardiac volumes, and then analyzes it offline in both multiplanar and rendered modes, using both static and moving images from a four-dimensional (4D) cine sequence simulating a full cardiac cycle. Spatiotemporal image correlation makes it possible to evaluate cardiac structures and their vascular connections, is less operator dependent, and allows cardiac volumes to be sent to specialists in tertiary centers for examination. Spatiotemporal image correlation can be combined with other software techniques, such as virtual organ computer-aided analysis (VOCAL) and automatic volume calculation (SonoAVC), to calculate cardiac function parameters. It can also be used in association with Omniview® in order to obtain standard echocardiographic planes using simple targets arterial rendering (STAR) and four-chamber view and swing technique (FAST). Recently, fetal intelligent navigation echocardiography (FINE), acquired from 3D STIC volumes, has made it possible to automatically obtain nine standard echocardiographic planes. In this article, we review the chief applications of 4D echocardiography using STIC technique in clinical practice.
How to cite this article
Araujo Júnior E, Tedesco GD, Carrilho MC, Peixoto AB, Carvalho FHC. 4D Fetal Echocardiography in Clinical Practice. Donald School J Ultrasound Obstet Gynecol 2015;9(4): 382-396.
Collapse
|
33
|
|
34
|
Bahado-Singh RO, Ertl R, Mandal R, Bjorndahl TC, Syngelaki A, Han B, Dong E, Liu PB, Alpay-Savasan Z, Wishart DS, Nicolaides KH. Metabolomic prediction of fetal congenital heart defect in the first trimester. Am J Obstet Gynecol 2014; 211:240.e1-240.e14. [PMID: 24704061 DOI: 10.1016/j.ajog.2014.03.056] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 02/21/2014] [Accepted: 03/31/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The objective of the study was to identify metabolomic markers in maternal first-trimester serum for the detection of fetal congenital heart defects (CHDs). STUDY DESIGN Mass spectrometry (direct injection/liquid chromatography and tandem mass spectrometry) and nuclear magnetic resonance spectrometry-based metabolomic analyses were performed between 11 weeks' and 13 weeks 6 days' gestation on maternal serum. A total of 27 CHD cases and 59 controls were compared. There were no known or suspected chromosomal or syndromic abnormalities indicated. RESULTS A total of 174 metabolites were identified and quantified using the 2 analytical methods. There were 14 overlapping metabolites between platforms. We identified 123 metabolites that demonstrated significant differences on a univariate analysis in maternal first-trimester serum in CHD vs normal cases. There was a significant disturbance in acylcarnitine, sphingomyelin, and other metabolite levels in CHD pregnancies. Predictive algorithms were developed for CHD detection. High sensitivity (0.929; 95% confidence interval [CI], 0.92-1.00) and specificity (0.932; 95% CI, 0.78-1.00) for CHD detection were achieved (area under the curve, 0.992; 95% CI, 0.973-1.0). CONCLUSION In the first such report, we demonstrated the feasibility of the use of metabolomic developing biomarkers for the first-trimester prediction of CHD. Abnormal lipid metabolism appeared to be a significant feature of CHD pregnancies.
Collapse
Affiliation(s)
- Ray O Bahado-Singh
- Department of Obstetrics and Gynecology, William Beaumont School of Medicine, Oakland University, Royal Oak, MI.
| | - Rebecca Ertl
- Harris Birthright Research Center for Fetal Medicine, King's College Hospital, London, England, UK
| | - Rupasri Mandal
- Department of Biological Sciences, Faculty of Science, University of Alberta, Edmonton, AB, Canada
| | - Trent C Bjorndahl
- Department of Biological Sciences, Faculty of Science, University of Alberta, Edmonton, AB, Canada
| | - Argyro Syngelaki
- Harris Birthright Research Center for Fetal Medicine, King's College Hospital, London, England, UK
| | - Beomsoo Han
- Department of Computing Science, Faculty of Science, University of Alberta, Edmonton, AB, Canada
| | - Edison Dong
- Department of Biological Sciences, Faculty of Science, University of Alberta, Edmonton, AB, Canada
| | - Philip B Liu
- Department of Biological Sciences, Faculty of Science, University of Alberta, Edmonton, AB, Canada
| | - Zeynep Alpay-Savasan
- Department of Obstetrics and Gynecology, William Beaumont School of Medicine, Oakland University, Royal Oak, MI
| | - David S Wishart
- Department of Biological Sciences, Faculty of Science, University of Alberta, Edmonton, AB, Canada; Department of Computing Science, Faculty of Science, University of Alberta, Edmonton, AB, Canada
| | - Kypros H Nicolaides
- Harris Birthright Research Center for Fetal Medicine, King's College Hospital, London, England, UK
| |
Collapse
|
35
|
Holtby HM. Anesthetic considerations for neonates undergoing modified Blalock-Taussig shunt and variations. Paediatr Anaesth 2014; 24:114-9. [PMID: 24237930 DOI: 10.1111/pan.12295] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2013] [Indexed: 11/29/2022]
Abstract
The first Blalock-Taussig (BT) shunt was reported in 1944, and during the last 70 years, the procedure has evolved with the development of new materials and devices, and surgical approaches. It has, however, remained central to the palliation of neonates with complex congenital heart disease. The indications have expanded from the original aim of alleviating cyanosis and the pathophysiological results of chronic hypoxemia. They now include lesions with single ventricles, and rehabilitation of small pulmonary arteries. The physiology and hemodynamics of BT shunt circulations are very complex, and adverse hemodynamic events can be difficult to recognize. The consequences of shunt failure can be fatal, and the mortality (3-15%) and morbidity remain distressingly high even in the current era. Neonates undergoing BT shunt procedures or undergoing noncardiac surgery with this anatomy are challenging for the anesthesiologists to manage. There is a significant incidence of periprocedural cardiac arrest, often related to myocardial ischemia. A clear understanding of the anatomy and physiology is important. Any discussion of BT shunt in the current era has to include consideration of hypoplastic left heart syndrome and 'single ventricle' physiology.
Collapse
Affiliation(s)
- Helen M Holtby
- Division of Cardiac Anaesthesia, Department of Anaesthesia and Pain Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
36
|
Letourneau KM, McDonald K, Soni R, Karlicki F, Horne D, Hall PF, Fransoo R. A Simple Effective Protocol to Increase Prenatal Detection of Critical Congenital Heart Disease. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2013. [DOI: 10.1177/8756479313517178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Prenatal diagnosis of congenital heart disease (CHD) during routine obstetric sonography has been aptly named the sonographer’s Achilles heel. Although CHD occurs more commonly than any other major congenital abnormality, the detection rate remains low. The goal of this study was to improve the prenatal diagnosis of CHD during routine obstetric sonography through the development and implementation of a simple and effective screening protocol.
Collapse
Affiliation(s)
| | | | - Reeni Soni
- Variety Children’s Heart Center, Winnipeg, MB, Canada
| | | | - David Horne
- University of Manitoba, Department of Cardiac Surgery, Winnipeg, MB, Canada
| | | | - Randall Fransoo
- University of Manitoba, Department of Community Health Sciences, Winnipeg, MB, Canada
| |
Collapse
|
37
|
Long F, Wang X, Fang S, Xu Y, Sun K, Chen S, Xu R. A potential relationship among beta-defensins haplotype, SOX7 duplication and cardiac defects. PLoS One 2013; 8:e72515. [PMID: 24009689 PMCID: PMC3757027 DOI: 10.1371/journal.pone.0072515] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 07/11/2013] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To determine the pathogenesis of a patient born with congenital heart defects, who had appeared normal in prenatal screening. METHODS In routine prenatal screening, G-banding was performed to analyse the karyotypes of the family and fluorescence in situ hybridization was used to investigate the 22q11.2 deletion in the fetus. After birth, the child was found to be suffering from heart defects by transthoracic echocardiography. In the following study, sequencing was used to search for potential mutations in pivotal genes. SNP-array was employed for fine mapping of the aberrant region and quantitative real-time PCR was used to confirm the results. Furthermore, other patients with a similar phenotype were screened for the same genetic variations. To compare with a control, these variations were also assessed in the general population. RESULTS The child and his mother each had a region that was deleted in the beta-defensin repeats, which are usually duplicated in the general population. Besides, the child carried a SOX7-gene duplication. While this duplication was not detected in his mother, it was found in two other patients with cardiac defects who also had the similar deletion in the beta-defensin repeats. CONCLUSION The congenital heart defects of the child were probably caused by a SOX7-gene duplication, which may be a consequence of the partial haplotype of beta-defensin regions at 8p23.1. To our knowledge, this is the first congenital heart defect case found to have the haplotype of beta-defensin and the duplication of SOX7.
Collapse
Affiliation(s)
- Fei Long
- Scientific Research Center, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China
| | - Xike Wang
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China
| | - Shaohai Fang
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China
| | - Yuejuan Xu
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China
| | - Kun Sun
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China
| | - Sun Chen
- Department of Pediatric Cardiology, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China
- * E-mail: (SC); (RX)
| | - Rang Xu
- Scientific Research Center, Xinhua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, P.R. China
- * E-mail: (SC); (RX)
| |
Collapse
|
38
|
Tello-Montoliu A, Seecheran NA, Angiolillo DJ. Successful pregnancy and delivery on prasugrel treatment: considerations for the use of dual antiplatelet therapy during pregnancy in clinical practice. J Thromb Thrombolysis 2012; 36:348-51. [DOI: 10.1007/s11239-012-0830-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
39
|
Donnelly JC, Malone FD. Early fetal anatomical sonography. Best Pract Res Clin Obstet Gynaecol 2012; 26:561-73. [PMID: 22776410 DOI: 10.1016/j.bpobgyn.2012.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 06/13/2012] [Indexed: 11/25/2022]
Abstract
Over the past decade, prenatal screening and diagnosis has moved from the second into the first trimester, with aneuploidy screening becoming both feasible and effective. With vast improvements in ultrasound technology, sonologists can now image the fetus in greater detail at all gestational ages. In the hands of experienced sonographers, anatomic surveys between 11 and 14 weeks can be carried out with good visualisation rates of many structures. It is important to be familiar with the normal development of the embryo and fetus, and to be aware of the major anatomical landmarks whose absence or presence may be deemed normal or abnormal depending on the gestational age. Some structural abnormalities will nearly always be detected, some will never be and some are potentially detectable depending on a number of factors.
Collapse
Affiliation(s)
- Jennifer C Donnelly
- Royal College of Surgeons in Ireland, Rotunda Hospital, Parnell Square, Dublin, Ireland.
| | | |
Collapse
|
40
|
Affiliation(s)
- Shakeel A Qureshi
- Evelina Children’s Hospital, 6th Floor, Westminster Bridge Road, London, SE1 7EH, UK
| | - Lee Benson
- Cardiac Diagnostic & Interventional Unit Cardiology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
| |
Collapse
|