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Outcome following, and impact of, prenatal identification of the candidates for the Norwood procedure

Published online by Cambridge University Press:  20 January 2005

Robin R Fountain-Dommer ,
Scott M Bradley ,
Andrew M Atz ,
Martha R Stroud ,
Geoffrey A Forbus  and
Girish S Shirali
Robin R Fountain-Dommer
Affiliation:
Department of Pediatrics (Cardiology), Medical University of South Carolina, Charleston, SC, USA
Scott M Bradley
Affiliation:
Department of Surgery (Cardiothoracic Surgery), Medical University of South Carolina, Charleston, SC, USA
Andrew M Atz
Affiliation:
Department of Pediatrics (Cardiology), Medical University of South Carolina, Charleston, SC, USA
Martha R Stroud
Affiliation:
Department of Surgery (Cardiothoracic Surgery), Medical University of South Carolina, Charleston, SC, USA
Geoffrey A Forbus
Affiliation:
Department of Pediatrics (Cardiology), Medical University of South Carolina, Charleston, SC, USA
Girish S Shirali
Affiliation:
Department of Pediatrics (Cardiology), Medical University of South Carolina, Charleston, SC, USA
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Abstract

Objectives: Our study evaluates hospital survival following prenatal identification of candidates for the Norwood procedure, and the impact of prenatal diagnosis on survival, preoperative stability, and postoperative morbidity. Methods: We reviewed records of all patients who were identified prenatally as candidates for the Norwood procedure, and compared them to all postnatally diagnosed patients who underwent the Norwood procedure between August 1995 and May 2002. Results: Of the 98 patients studied, 45 (46%) were diagnosed prenatally. Of these, 35 underwent the Norwood procedure, 29 (83%) of who survived. Thus, 29 of 45 (64%) patients survived from prenatal diagnosis to discharge following the Norwood procedure. Of the 53 postnatally diagnosed patients who underwent the Norwood procedure, 42 (79%) survived. Prenatal diagnosis was not associated with improvement in survival, preoperative stability, or postoperative morbidity. By multivariate analysis, ascending aortic diameter equal to or greater than 2 mm (p = 0.01), and gestational age 36 weeks or greater (p = 0.01) independently predicted survival. Based on this, patients were stratified into groups at low risk, consisting of 69 patients, and at high risk, consisting of 19 patients. Prenatal diagnosis was unassociated with improved survival in either group. Results were unchanged when the analysis was restricted to patients with hypoplasia of the left heart. Conclusion: From the time of prenatal diagnosis, 64% of patients survived to discharge following the Norwood procedure. Prenatal diagnosis did not affect preoperative stability, survival or postoperative morbidity. This remained the case after stratifying patients by risk, or restricting analysis to patients with hypoplasia of the left heart. Ascending aortic diameter and gestational age independently predicted survival.

Keywords

Norwood procedureprenatal diagnosisechocardiography
Type
Original Article
Information
Cardiology in the Young , Volume 14 , Issue 1 , February 2004 , pp. 32 - 38
Copyright
© 2004 Cambridge University Press

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References

Allan LD, Sharland GK, Milburn A, et al. Prospective diagnosis of 1006 consecutive cases of congenital heart disease in the fetus. J Am Coll Cardiol 1994; 23: 1452–1458.Google Scholar
Jacobs ML, Blackstone EH, Bailey LL. Intermediate survival in neonates with aortic atresia: a multi-institutional study. The Congenital Surgeons Society. J Thorac Cardiovasc Surg 1998; 116: 417–431.Google Scholar
Chang AC, Huhta JC, Yoon GY, et al. Diagnosis, transport, and outcome in fetuses with left ventricular outflow tract obstruction. J Thorac Cardiovasc Surg 1991; 102: 841–848.Google Scholar
Eapen RS, Rowland DG, Franklin WH. Effect of prenatal diagnosis of critical left heart obstruction on perinatal morbidity and mortality. Am J Perinatol 1998; 15: 237–242.Google Scholar
Kern JH, Hayes CJ, Michler RE, Gersony WM, Quaegebeur JM. Survival and risk factor analysis for the Norwood procedure for hypoplastic left heart syndrome. Am J Cardiol 1997; 80: 170–174.Google Scholar
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
Tworetzky W, McElhinney DB, Reddy VM, Brook MM, Hanley FL, Silverman NH. Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome. Circulation 2001; 103: 1269–1273.Google Scholar
Mahle WT, Clancy RR, McGaurn SP, Goin JE, Clark BJ. Impact of prenatal diagnosis on survival and early neurologic morbidity in neonates with the hypoplastic left heart syndrome. Pediatrics 2001; 107: 1277–1282.Google Scholar
Brackley KJ, Kilby MD, Wright JG, et al. Outcome after prenatal diagnosis of hypoplastic left heart syndrome: a case series. Lancet 2000; 356: 1143–1147.Google Scholar
Allan LD, Apfel HD, Printz BF. Outcome after prenatal diagnosis of the hypoplastic left heart syndrome. Heart 1998; 79: 371–373.Google Scholar
Andrews R, Tulloh R, Sharland G, et al. Outcome of staged reconstruction surgery for hypoplastic left heart syndrome following antenatal diagnosis. Arch Dis Child 2001; 85: 474–477.Google Scholar
Bove EL, Lloyd TR. Staged reconstruction for hypoplastic left heart syndrome. Annals of Surgery 1996; 224: 387–395.Google Scholar
Ishino K, Stumper O, De Giovanni JJV, et al. The modified Norwood procedure for hypoplastic left heart syndrome: early to intermediate results of 120 patients with particular reference to aortic arch repair. J Thorac Cardiovasc Surg 1999; 117: 920–930.Google Scholar
Daebritz SH, Nollert GD, Zurakowski D, et al. Results of Norwood stage I operation: comparison of hypoplastic left heart syndrome with other malformations. J Thorac Cardiovasc Surg 2000; 119: 358–367.Google Scholar
Bradley SM, Simsic JM, Atz AM, Dorman BH. The infant with single ventricle and excessive pulmonary blood flow: results of a strategy of pulmonary artery division and shunt. Ann Thorac Surg 2002; 74: 805–810.Google Scholar
L'enfant C. Report of the task force on research in pediatric cardiovascular disease. Circulation 2002; 106: 1037–1042.Google Scholar
Chang RK, Chen AY, Klitzner TS. Clinical management of infants with hypoplastic left heart syndrome in the United States, 1988–97. Pediatrics 2002; 110 (2 pt 1): 292–298.Google Scholar
Forbess JM, Cook N, Roth SJ, Serraf A, Mayer JE, Jonas RA. Ten-year institutional experience with palliative surgery for hypoplastic left heart syndrome. Circulation 1995; 92: II-262–II-266.Google Scholar
Sklansky M, Tang A, Levy D, et al. Maternal psychological impact of fetal echocardiography. J Am Soc Echocardiogr 2002; 15: 159–166.Google Scholar