Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-26T20:56:40.719Z Has data issue: false hasContentIssue false
  • English
  • Français

Perinatal and early postnatal outcomes for fetuses with prenatally diagnosed d-transposition of the great arteries: a prospective cohort study assessing the effect of standardised prenatal consultation

Published online by Cambridge University Press:  08 August 2017

Yanji Qu ,
Shusheng Wen ,
Xiaoqing Liu ,
Wei Pan ,
Fengzhen Han ,
Jinzhuang Mai ,
Yanqiu Ou ,
Zhiqiang Nie ,
Xiangmin Gao  and
Yong Wu
...Show all authors
Yanji Qu
Affiliation:
Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
Shusheng Wen
Affiliation:
Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
Xiaoqing Liu
Affiliation:
Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
Wei Pan
Affiliation:
Maternal-Fetal Cardiac Department, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
Fengzhen Han
Affiliation:
Department of Obstetrics, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
Jinzhuang Mai
Affiliation:
Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
Yanqiu Ou
Affiliation:
Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
Zhiqiang Nie
Affiliation:
Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
Xiangmin Gao
Affiliation:
Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
Yong Wu
Affiliation:
Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
Richard G. Ohye
Affiliation:
Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
Jimei Chen*
Affiliation:
Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
Jian Zhuang*
Affiliation:
Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
*
Correspondence to: Jimei Chen, Jian Zhuang, Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Yuexiu District, Guangzhou, Guangdong 510080, China. Tel: +86 20 8382 7812; Fax: +86 20 8387 8129; E-mail: [email protected] (Jimei Chen) and [email protected] (Jian Zhuang)
Correspondence to: Jimei Chen, Jian Zhuang, Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Yuexiu District, Guangzhou, Guangdong 510080, China. Tel: +86 20 8382 7812; Fax: +86 20 8387 8129; E-mail: [email protected] (Jimei Chen) and [email protected] (Jian Zhuang)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The aim of this study was to explore perinatal and early postnatal outcomes in fetuses with prenatally diagnosed d-transposition of the great arteries and impacts of standardised prenatal consultation.

Methods

All fetuses with prenatally diagnosed d-transposition of the great arteries prospectively enrolled at South China cardiac centre from 2011 to 2015. Standardised prenatal consultation was introduced in 2013 and comprehensive measures were implemented, such as establishing fetal CHD Outpatient Consultation Service, performing standard prenatal consultation according to specifications, and establishing a multidisciplinary team with senior specialists performing in-person consultations. Continuous follow-up investigation was conducted. Perinatal and postnatal outcomes were compared before and after consultation including live birth, elective termination of pregnancy, spontaneous fetal death, stillbirths, referral for surgery, and survival.

Results

In all, 146 fetuses were enrolled with 41 (28%) lost to follow-up. Among 105 remaining fetuses, 29 (28%) were live births and 76 (72%) were terminated. After consultation, live birth rate was higher (50 versus 33%) and termination rate was lower (50 versus 76%), although there was no statistical significance. Excluding three live births without postnatal d-transposition of the great arteries, 65% (17/26) underwent arterial switch operation within 30 days. A total of three in-hospital deaths occurred and during the 10-month follow-up period, one death was observed. In one case, the switch procedure was performed at 13 months and the infant survived. Out of eight infants without arterial switch operation, two died.

Conclusions

Live birth rate increased after consultation; however, termination remained high. Combining termination, patients without arterial switch operation, and operative mortality, outcomes of d-transposition of the great arteries infants can be improved. Standard consultation, multidisciplinary collaboration, and improved perinatal care are important to improve outcomes.

Keywords

CHDtransposition of the great arteriesprenatal diagnosis
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 1 , January 2018 , pp. 66 - 75
Check for updates
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Yanji Qu and Shusheng Wen are co-first authors.

References

1. Botto, LD, Correa, A, Erickson, JD. Racial and temporal variations in the prevalence of heart defects. Pediatrics 2001; 107: E32.Google Scholar
2. Khairy, P, Clair, M, Fernandes, SM, et al. Cardiovascular outcomes after the arterial switch operation for D-transposition of the great arteries. Circulation 2013; 127: 331–339.Google Scholar
3. Quartermain, MD. Transposition of the great arteries. In: Rychik J, Tian Z (eds). Fetal Cardiovascular Imaging: A Disease-Based Approach, Elsevier Inc., Philadelphia, PA, 2012; 153–163.Google Scholar
4. Liebman, J, Cullum, L, Belloc, NB. Natural history of transposition of the great arteries. Anatomy and birth and death characteristics. Circulation 1969; 40: 237–262.CrossRefGoogle ScholarPubMed
5. Van Velzen, CL, Haak, MC, Reijnders, G, et al. Prenatal detection of transposition of the great arteries reduces mortality and morbidity. Ultrasound Obstet Gynecol 2015; 45: 320–325.Google Scholar
6. Calderon, J, Angeard, N, Moutier, S, Plumet, MH, Jambaque, I, Bonnet, D. Impact of prenatal diagnosis on neurocognitive outcomes in children with transposition of the great arteries. J Pediatr 2012; 161: 94–98.e1.Google Scholar
7. Escobar-Diaz, MC, Freud, LR, Bueno, A, et al. Prenatal diagnosis of transposition of the great arteries over a 20-year period: improved but imperfect. Ultrasound Obstet Gynecol 2015; 45: 678–682.Google Scholar
8. Khoshnood, B, De Vigan, C, Vodovar, V, et al. Trends in prenatal diagnosis, pregnancy termination, and perinatal mortality of newborns with congenital heart disease in France, 1983-2000: a population-based evaluation. Pediatrics 2005; 115: 95–101.Google Scholar
9. Raboisson, MJ, Samson, C, Ducreux, C, et al. Impact of prenatal diagnosis of transposition of the great arteries on obstetric and early postnatal management. Eur J Obstet Gynecol Reprod Biol 2009; 142: 18–22.Google Scholar
10. Bertagna, F, Rakza, T, Vaksmann, G, et al. Transposition of the great arteries: factors influencing prenatal diagnosis. Prenat Diagn 2014; 34: 534–537.CrossRefGoogle ScholarPubMed
11. Blyth, M, Howe, D, Gnanapragasam, J, Wellesley, D. The hidden mortality of transposition of the great arteries and survival advantage provided by prenatal diagnosis. BJOG 2008; 115: 1096–1100.CrossRefGoogle ScholarPubMed
12 Sklansky, MS, Berman, DP, Pruetz, JD, Chang, RK. Prenatal screening for major congenital heart disease: superiority of outflow tracts over the 4-chamber view. J Ultrasound Med 2009; 28: 889–899.Google Scholar
13. Carvalho, JS, Mavrides, E, Shinebourne, EA, Campbell, S, Thilaganathan, B. Improving the effectiveness of routine prenatal screening for major congenital heart defects. Heart 2002; 88: 387–391.Google Scholar
14. Ogge, G, Gaglioti, P, Maccanti, S, Faggiano, F, Todros, T. Prenatal screening for congenital heart disease with four-chamber and outflow-tract views: a multicenter study. Ultrasound Obstet Gynecol 2006; 28: 779–784.Google Scholar
15. Levy, DJ, Pretorius, DH, Rothman, A, et al. Improved prenatal detection of congenital heart disease in an integrated health care system. Pediatr Cardiol 2013; 34: 670–679.Google Scholar
16. Yang, XY, Li, XF, Lu, XD, Liu, YL. Incidence of congenital heart disease in Beijing, China. Chin Med J 2009; 122: 1128–1132.Google Scholar
17. Guangdong General Hospital GCI, Guangdong Eugenics Association Congenital Heart Disease Committee. Prenatal consultation specification of fetal congenital heart disease in Guangdong province. Int Med Health Guidance News 2015; 21: 1033–1036.Google Scholar
18. Guangdong General Hospital GCI, Guangdong Eugenics Association Congenital Heart Disease Committee. Fetal cardiac ultrasound technology specification in Guangdong province. Int Med Health Guidance News 2015; 21: 739–741.Google Scholar
19. Martins, P, Castela, E. Transposition of the great arteries. Orphanet J Rare Dis 2008; 3: 27.Google Scholar
20. Oganization, WH. International Statistical Classification of Diseases and Related Health Problems. Tenth Revision. Vol. 2. World Health Organization, Geneva, Switzerland, 1993, 129 pp.Google Scholar
21. Dhanardhono, T, Thia, E, Wei, X, Saktini, F, Dewi, PK, Yeo, GS. Incidence and outcome of prenatally diagnosed, chromosomally normal congenital heart defects in Singapore. Singapore Med J 2012; 53: 643–647.Google Scholar
22. Khoo, NS, Van Essen, P, Richardson, M, Robertson, T. Effectiveness of prenatal diagnosis of congenital heart defects in South Australia: a population analysis 1999-2003. Aust N Z J Obstet Gynaecol 2008; 48: 559–563.Google Scholar
23. Khoshnood, B, Lelong, N, Andrieu, T, et al. Assessing sociodemographic differences (or lack thereof) in prenatal diagnosis of congenital heart defects: a population-based study. BMJ Open 2016; 6: e009353.Google Scholar
24. Lee, JE, Jung, KL, Kim, SE, Nam, SH, Choi, SJ, Oh, SY, et al. Prenatal diagnosis of congenital heart disease: trends in pregnancy termination rate, and perinatal and 1-year infant mortalities in Korea between 1994 and 2005. J Obstet Gynaecol Res 2010; 36: 474–478.Google Scholar
25. Donofrio, MT, Moon-Grady, AJ, Hornberger, LK, et al. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation 2014; 129: 2183–2242.Google Scholar
26. Bonnet, D, Coltri, A, Butera, G, et al. Detection of transposition of the great arteries in fetuses reduces neonatal morbidity and mortality. Circulation 1999; 99: 916–918.Google Scholar
27. Qu, Y, Liu, X, Zhuang, J, et al. Incidence of congenital heart disease: the 9-year experience of the Guangdong Registry of Congenital Heart Disease, China. PloS One 2016; 11(7): e0159257.Google Scholar