Pediatric Cardiology and Cardiac Surgery
Vol.26 No.2 2010 (106-112)
Kohta Takei,1) Satoshi Yasukochi,1) Kiyohiro Takigiku,1) Nao Inoue,1) Yusuke Nakano,1) Tesshu Otagiri,1) Yuichiro Hashida,1) Yoshiyuki Maekawa,2) Kentaro Umezu,2) Takahiko Sakamoto,2) and Yorikazu Harada2)
Departments of 1)Cardiology and 2)Cardiovascular Surgery, Nagano Children’s Hospital, Nagano, Japan
Background: Recent advances in fetal echocardiography have made the diagnosis of congenital heart disease (CHD) in utero more accurate. The aim of this study was to clarify the impact of fetal diagnosis (FD) of CHD on the outcome and perinatal management of those who required either surgery or catheter intervention immediately after birth.
Method: We investigated the clinical records of 212 patients with CHD who had been treated during the neonatal period at Nagano Children’s Hospital between June 1993 and June 2009.
Results: In 53 patients with hypoplastic left heart syndrome, FD contributed to preventing unexpected ductal shock [FD (+) 1/18 (6%) vs. FD (-) 11/30 (37%)]. In 77 patients with coarctation of the aorta or an interrupted aortic arch, FD also contributed to preventing ductal shock [FD (+) 0/11 vs. FD (-) 11/66)]. Of 60 patients with transposition of great arteries, 26 patients (43%) needed an emergency balloon atrioseptostomy (BAS), one of which was diagnosed in utero and could undergo elective BAS. Of 14 patients with severe Ebstein anomaly or tricuspid valve dysplasia, neonatal transfer was avoided for the 5 patients who had a FD, and FD contributed to a good pre-operative condition. The outcome of the Starnes operation was better in inborn patients (inborn 5/5 vs. outborn 1/2). Of 8 patients with critical aortic stenosis, 5 patients were diagnosed in utero with afterload mismatch status. They were delivered by elective caesarean section and balloon aortic valvoplasties were performed immediately after caesarean section.
Conclusions: Fetal diagnosis of CHD contributed to prospective medical intervention soon after birth with appropriate timing and at an appropriate institution.