Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-26T13:57:15.787Z Has data issue: false hasContentIssue false
  • English
  • Français

Emerging trends in the prenatal diagnosis of complex CHD and its influence on infant mortality in this cohort

Published online by Cambridge University Press:  26 December 2018

Sudheer R. Gorla ,
Abhishek Chakraborty ,
Ashish Garg ,
Rubee A. Gugol ,
Richard E. Kardon  and
Sethuraman Swaminathan Open the ORCID record for Sethuraman Swaminathan [Opens in a new window]
Sudheer R. Gorla
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, USA
Abhishek Chakraborty
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, USA
Ashish Garg
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, USA
Rubee A. Gugol
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, USA
Richard E. Kardon
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, USA
Sethuraman Swaminathan*
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, USA
*
Author for correspondence: Sethuraman Swaminathan, MD, 1611 NW 12th Avenue, NW Room 109 Miami, FL 33136, USA. Tel: 305-585-6683; Fax: 305-324-6012; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Fetal echocardiography is the main modality of prenatal diagnosis of CHD. This study was done to describe the trends and benefits associated with prenatal diagnosis of complex CHD at a tertiary care centre.

Methods

Retrospective chart review of patients with complex CHD over an 18-year period was performed. Rates of prenatal detection along with early and late infant mortality outcomes were studied.

Results

Of 381 complex CHD patients born during the study period, 68.8% were diagnosed prenatally. Prenatal detection rate increased during the study period from low-50s in the first quarter to mid-80s in the last quarter (p=0.001). Rate of detection of conotruncal anomalies increased over the study period. No infant mortality benefit was noted with prenatal detection.

Conclusions

Improved obstetrical screening indications and techniques have contributed to higher proportions of prenatal diagnosis of complex CHD. However, prenatal diagnosis did not confer survival benefits in infancy in our study.

Keywords

Prenatal diagnosiscomplex CHDinfant mortalityfetal echocardiography
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 3 , March 2019 , pp. 270 - 276
Copyright
© Cambridge University Press 2018. 

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

Cite this article: Gorla SR, Chakraborty A, Garg A, Gugol RA, Kardon RE, Swaminathan S. (2019) Emerging trends in the prenatal diagnosis of complex CHD and its influence on infant mortality in this cohort. Cardiology in the Young29: 270–276. doi: 10.1017/S1047951118002147

References

1. Rosano, A, Botto, LD, Botting, B, Mastroiacovo, P. Infant mortality and congenital anomalies from 1950 to 1994: an international perspective. J Epidemiol Commun Health 2000; 54: 660–666.Google Scholar
2. Hoffman, JI, Kaplan, S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 1890–1900.Google Scholar
3. van der Linde, D, Konings, EE, Slager, MA, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol 2011; 58: 2241–2247.Google Scholar
4. 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
5. Friedman, AH, Kleinman, CS, Copel, JA. Diagnosis of cardiac defects: where we’ve been, where we are and where we’re going. Prenat Diagn 2002; 22: 280–284.Google Scholar
6. Gorla, SR, Hsu, DT, Kulkarni, A. Lack of Association of ST-T Wave Abnormalities to Congenital Heart Disease in Neonates. Congenit Heart Dis 2016; 11: 403–408.Google Scholar
7. Landis, BJ, Levey, A, Levasseur, SM, et al. Prenatal diagnosis of congenital heart disease and birth outcomes. Pediatr Cardiol 2013; 34: 597–605.Google Scholar
8. Brown, KL, Ridout, DA, Hoskote, A, Verhulst, L, Ricci, M, Bull, C. Delayed diagnosis of congenital heart disease worsens preoperative condition and outcome of surgery in neonates. Heart (British Cardiac Society) 2006; 92: 1298–1302.Google Scholar
9. Sivarajan, V, Penny, DJ, Filan, P, Brizard, C, Shekerdemian, LS. Impact of antenatal diagnosis of hypoplastic left heart syndrome on the clinical presentation and surgical outcomes: the Australian experience. J Paediatr Child Health 2009; 45: 112–117.Google Scholar
10. 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
11. Kumar, RK, Newburger, JW, Gauvreau, K, Kamenir, SA, Hornberger, LK. Comparison of outcome when hypoplastic left heart syndrome and transposition of the great arteries are diagnosed prenatally versus when diagnosis of these two conditions is made only postnatally. Am J Cardiol 1999; 83: 1649–1653.Google Scholar
12. Khoshnood, B, Lelong, N, Houyel, L, et al. Impact of prenatal diagnosis on survival of newborns with four congenital heart defects: a prospective, population-based cohort study in France (the EPICARD Study). BMJ Open 2017; 7: e018285.Google Scholar
13. Friedberg, MK, Silverman, NH, Moon-Grady, AJ, et al. Prenatal detection of congenital heart disease. J Pediatr 2009; 155: 26–31; 31.e21.Google Scholar
14. Pinto, NM, Keenan, HT, Minich, LL, Puchalski, MD, Heywood, M, Botto, LD. Barriers to prenatal detection of congenital heart disease: a population-based study. Ultrasound Obstet Gynecol 2012; 40: 418–425.Google Scholar
15. Garne, E, Stoll, C, Clementi, M, Euroscan, G. Evaluation of prenatal diagnosis of congenital heart diseases by ultrasound: experience from 20 European registries. Ultrasound Obstet Gynecol 2001; 17: 386–391.Google Scholar
16. Marek, J, Tomek, V, Skovranek, J, Povysilova, V, Samanek, M. Prenatal ultrasound screening of congenital heart disease in an unselected national population: a 21-year experience. Heart (British Cardiac Society) 2011; 97: 124–130.Google Scholar
17. Liberman, RF, Getz, KD, Lin, AE, et al. Delayed diagnosis of critical congenital heart defects: trends and associated factors. Pediatrics. 2014; 134: e373–381.Google Scholar
18. Quartermain, MD, Pasquali, SK, Hill, KD, et al. Variation in prenatal diagnosis of congenital heart disease in infants. Pediatrics. 2015; 136: e378–385.Google Scholar
19. International Society of Ultrasound in Obstetrics and Gynecology, Carvalho, JS, et al. ISUOG Practice Guidelines (updated): sonographic screening examination of the fetal heart. Ultrasound Obstet Gynecol 2013; 41: 348–359.Google Scholar
20. 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
21. Carvalho, JS, Mavrides, E, Shinebourne, EA, Campbell, S, Thilaganathan, B. Improving the effectiveness of routine prenatal screening for major congenital heart defects. Heart (British Cardiac Society) 2002; 88: 387–391.Google Scholar
22. Chu, C, Yan, Y, Ren, Y, Li, X, Gui, Y. Prenatal diagnosis of congenital heart diseases by fetal echocardiography in second trimester: a Chinese multicenter study. Acta Obstetricia et Gynecologica Scandinavica 2017; 96: 454–463.Google Scholar
23. Sekar, P, Heydarian, HC, Cnota, JF, Hornberger, LK, Michelfelder, EC. Diagnosis of congenital heart disease in an era of universal prenatal ultrasound screening in southwest Ohio. Cardiol Young 2015; 25: 35–41.Google Scholar
24. 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
25. Acherman, RJ, Evans, WN, Luna, CF, et al. Prenatal detection of congenital heart disease in southern Nevada: the need for universal fetal cardiac evaluation. J Ultrasound Med: Off J Am Inst Ultrasound Med 2007; 26: 1715–1719; quiz 1720-1711.Google Scholar
26. Swanson, TM, Selamet Tierney, ES, Tworetzky, W, Pigula, F, McElhinney, DB. Truncus arteriosus: diagnostic accuracy, outcomes, and impact of prenatal diagnosis. Pediatr Cardiol 2009; 30: 256–261.Google Scholar
27. Levey, A, Glickstein, JS, Kleinman, CS, et al. The impact of prenatal diagnosis of complex congenital heart disease on neonatal outcomes. Pediatr Cardiol. 2010; 31: 587–597.Google Scholar
28. Mazwi, ML, Brown, DW, Marshall, AC, et al. Unplanned reinterventions are associated with postoperative mortality in neonates with critical congenital heart disease. J Thorac Cardiovasc Surg 2013; 145: 671–677.Google Scholar
29. Wright, LK, Ehrlich, A, Stauffer, N, Samai, C, Kogon, B, Oster, ME. Relation of prenatal diagnosis with one-year survival rate for infants with congenital heart disease. Am J Cardiol 2014; 113: 1041–1044.Google Scholar