043 Management of Adults With Congenital Heart Disease Using Telemedicine Across Western Canada - A 3 Year Experience

Abstract

nancies andhaveat least a two-fold increasedprobabilityof congenital heart disease (CHD) compared to singletons. Nonetheless, data on the CHD spectrum and outcome of multiple pregnancies are scarce. METHODS: We reviewed all multiple pregnancies with a diagnosis of CHD in 1 fetus at our institution between January 2000 and June 2010. Excluded from the study were cases with: a) reversible cardiac anomalies such as twin-twin transfusion syndrome; b) single hearts in conjoined twins; c) acardia with no CHD in one fetus and; d) arrhythmias other than complete heart block (CHB). Maternal and fetal clinical data were reviewed and compared to outcomes. Results are expressed as numbers, ratios and mean with SD. RESULTS: Overall 2026 cases had a fetal diagnosis of CHD during the study period, including 105 (5%) fetuses from 98 pregnancies (92 twins; 6 triplets). A quarter of multiple pregnancies (23/98) resulted from assisted reproduction therapy. Obstructive left and right heart lesions were common and accounted for 34/105 (35%) cases each. Single ventricle physiology occurred in 38 (36%). The table compares extracardiac anomalies and early outcomes for fetuses with single versus biventricular physiology. Survival to surgery was significantly worse for fetuses of mono-amniotic compared to di-amniotic pregnancies (OR 0.076, P 0.02), with extra-cardiac abnormalities (OR 0.369, P 0.02), and with premature delivery (OR 0.391, P 0.001).