Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-23T04:26:28.710Z Has data issue: false hasContentIssue false
  • English
  • Français

Prenatal diagnosis of CHDs: a simple ultrasound prediction model to estimate the probability of the need for neonatal cardiac invasive therapy

Published online by Cambridge University Press:  27 April 2015

Pablo Marantz ,
Sofía Grinenco ,
Fabio Pestchanker ,
César H. Meller  and
Gustavo Izbizky
Pablo Marantz
Affiliation:
Foetal Medicine Unit, Hospital Italiano de Buenos Aires, Beuno Aires, Argentina Department of Pediatric Cardiology, Hospital Italiano de Buenos Aires, Beuno Aires, Argentina Department of Pediatric Cardiology, Fundación Hospitalaria, Hospital Italiano de Buenos Aires, Beuno Aires, Argentina
Sofía Grinenco*
Affiliation:
Foetal Medicine Unit, Hospital Italiano de Buenos Aires, Beuno Aires, Argentina Department of Pediatric Cardiology, Hospital Italiano de Buenos Aires, Beuno Aires, Argentina Department of Pediatric Cardiology, Fundación Hospitalaria, Hospital Italiano de Buenos Aires, Beuno Aires, Argentina
Fabio Pestchanker
Affiliation:
Department of Pediatric Cardiology, Hospital Italiano de Buenos Aires, Beuno Aires, Argentina
César H. Meller
Affiliation:
Foetal Medicine Unit, Hospital Italiano de Buenos Aires, Beuno Aires, Argentina Department of Obstetrics and Gynecology, Hospital Italiano de Buenos Aires, Beuno Aires, Argentina
Gustavo Izbizky
Affiliation:
Foetal Medicine Unit, Hospital Italiano de Buenos Aires, Beuno Aires, Argentina Department of Obstetrics and Gynecology, Hospital Italiano de Buenos Aires, Beuno Aires, Argentina
*
Correspondence to: S. Grinenco, Hospital Italiano de Buenos Aires. Potosí 4135, (C1199ACI) Buenos Aires, Argentina. Tel: +5411 956 021 1530; Fax: +5411 49 590 200 1577; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

To develop a prediction model based on echocardiographic findings to estimate the probability of the need for neonatal cardiac invasive therapy, including cardiac surgery or catheter-based therapy, in foetuses with CHD.

Methods

Retrospective cohort study: a prediction model was developed based on echocardiographic findings on the examination of the four-chamber, the three-vessel, and the three-vessel and tracheal views. We assessed performance using the area under the curve of the receiver operating characteristic.

Results

Among 291 patients with prenatal diagnosis of CHD and complete follow-up, 175 (60.1%) required neonatal cardiac invasive therapy. The variables “functionally single ventricle”, “great artery reverse flow”, and “congenital heart block” had a discrimination value of 100% and were excluded from the model. In univariate and multivariate analysis, “non-visualisation of a great vessel”, “asymmetry of the great vessels”, “visualisation of one atrioventricular valve”, and “ventricular asymmetry” were significantly associated with the need for neonatal cardiac invasive therapy. The area under the receiver operating characteristic curve was 0.9324 (95% CI 0.92–0.97).

Conclusions

A prediction model based on echocardiographic findings in foetuses with CHD, even without a definite diagnosis, allows an accurate estimation of the probability of requiring neonatal cardiac invasive therapy. This can modify patient care, especially in regions where a Foetal Medicine Specialist or a Paediatric Cardiologist is not available and referral may be extremely difficult due to social and economic barriers.

Keywords

Foetal heartprenatal diagnosisprediction modelCHDechocardiography
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 2 , February 2016 , pp. 347 - 353
Check for updates
Copyright
© Cambridge University Press 2015 

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.)

References

1. Jaeggi, ET, Sholler, GF, Jones, OD, Cooper, SG. Comparative analysis of pattern, management and outcome of pre-versus postnatally diagnosed major congenital heart disease: a population-based study. Ultrasound Obstet Gynecol 2001; 17: 380–385.Google Scholar
2. Van Aerschot, I, Rosenblatt, J, Boudjemline, Y. Foetal cardiac interventions: myths and facts. Arch Cardiovasc Dis 2012; 105: 366–372.Google Scholar
3. Quartermain, MD, Glatz, AC, Goldberg, DJ, et al. Pulmonary outflow tract obstruction in foetuses with complex congenital heart disease: predicting the need for neonatal intervention. Ultrasound Obstet Gynecol 2013; 41: 47–53.Google Scholar
4. Yagel, S, Cohen, SM, Achiron, R. Examination of the foetal heart by five short-axis views: a proposed screening method for comprehensive cardiac evaluation. Ultrasound Obstet Gynecol 2001; 17: 367–369.CrossRefGoogle ScholarPubMed
5. Carvalho, JS, Allan, LD, Chaoui, R, et al. ISUOG Practice Guidelines (updated): sonographic screening examination of the foetal heart. Ultrasound Obstet Gynecol 2013; 41: 348–359.Google Scholar
6. Hanley, JA, McNeil, BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982; 143: 29–36.Google Scholar
7. Wasson, JH, Sox, HC, Neff, RK, Goldman, L. Clinical prediction rules. Applications and methodological standards. N Engl J Med 1985; 313: 793–799.Google Scholar
8. Berning, RA, Silverman, NH, Villegas, M, Sahn, DJ, Martin, GR, Rice, MJ. Reversed shunting across the ductus arteriosus or atrial septum in utero heralds severe congenital heart disease. J Am Coll Cardiol 1996; 27: 481–486.Google Scholar
9. Mäkikallio, K, McElhinney, DB, Levine, JC, et al. Foetal aortic valve stenosis and the evolution of hypoplastic left heart syndrome: patient selection for foetal intervention. Circulation 2006; 113: 1401–1405.Google Scholar
10. Todros, T, Paladini, D, Chiappa, E, et al. Pulmonary stenosis and atresia with intact ventricular septum during prenatal life. Ultrasound Obstet Gynecol 2003; 21: 228–233.Google Scholar
11. Hirji, A, Bernasconi, A, McCrindle, BW, et al. Outcomes of prenatally diagnosed tetralogy of Fallot: implications for valve-sparing versus transannular patch. Can J Cardiol 2010; 26: e1–e6.Google Scholar
12. Escribano, D, Herraiz, I, Granados, M, Arbues, J, Mendoza, A, Galindo, A. Tetralogy of Fallot: prediction of outcome in the mid-second trimester of pregnancy. Prenat Diagn 2011; 31: 1126–1133.Google Scholar
13. Gómez-Montes, E, Herraiz, I, Mendoza, A, Escribano, D, Galindo, A. Prediction of coarctation of the aorta in the second half of pregnancy. Ultrasound Obstet Gynecol 2013; 41: 298–305.Google Scholar
14. Jowett, V, Aparicio, P, Santhakumaran, S, Seale, A, Jicinska, H, Gardiner, HM. Sonographic predictors of surgery in foetal coarctation of the aorta. Ultrasound Obstet Gynecol 2012; 40: 47–54.Google Scholar
15. Matsui, H, Mellander, M, Roughton, M, Jicinska, H, Gardiner, HM. Morphological and physiological predictors of foetal aortic coarctation. Circulation 2008; 118: 1793–17801.CrossRefGoogle ScholarPubMed
16. Vlahos, AP, Lock, JE, McElhinney, DB, van der Velde, ME. Hypoplastic left heart syndrome with intact or highly restrictive atrial septum: outcome after neonatal transcatheter atrial septostomy. Circulation 2004; 109: 2326–2330.Google Scholar
17. Marshall, AC, Levine, J, Morash, D, et al. Results of in utero atrial septoplasty in foetuses with hypoplastic left heart syndrome. Prenat Diagn 2008; 28: 1023–1028.Google Scholar
18. Jouannic, JM, Gavard, L, Fermont, L, et al. Sensitivity and specificity of prenatal features of physiological shunts to predict neonatal clinical status in transposition of the great arteries. Circulation 2004; 110: 1743–1746.Google Scholar
19. Maeno, YV, Kamenir, SA, Sinclair, B, van der Velde, ME, Smallhorn, JF, Hornberger, LK. Prenatal features of ductus arteriosus constriction and restrictive foramen ovale in d-transposition of the great arteries. Circulation 1999; 99: 1209–1214.Google Scholar
20. Guerchicoff, M, Marantz, P, Infante, J, et al. Evaluation of the impact of early diagnosis of congenital heart disease. Arch Argent Pediatr 2004; 102: 445–450.Google Scholar