OC15.05: Impact of training in the prenatal recognition of major cardiac anomalies

Abstract

The objective of our project was to evaluate the impact of specialist training of ultrasonographers in the prenatal identification of major cardiac anomalies. We reviewed all the cases of congenital heart disease (CHD) reported to our regional congenital anomalies database from 1994 to 2004. The information from the database was checked against the admissions at the regional centre for paediatric cardiology and post-mortem data from the regional neonatal and paediatric pathology centre for the same time. We defined as major cardiac anomalies those cases that needed intervention by either surgery or catheterisation within the first month of life. Prior to 1998 most ultrasonographers would be trained to examine the 4 chamber view of the heart. In 1998 we introduced a course that included hand's on training in examination of the outflow tracts and demonstrating videos of common abnormalities. We have retrospectively examined detection rates and correlated these with the introduction of the regional training scheme. During the study period there were 951 cases with CHD. The incidence of CHD was 0.33% for the study population. The overall prenatal detection rate for CHD was 40.3%. For anomalies usually seen at the 4 chamber view the detection rate improved from 47.2% to 65.4% after the training courses (p < 0.005). This improvement was also evident for anomalies that require the cardiac outflow tracts to be visualised (from 20.2% to 32% p < 0.005). The biggest gain was in cases with isolated CHD where detection rates improved from 33%–54% and from 8%–19% respectively (p < 0.005). Improved training of the ultrasonographers, particularly enabling them to identify the outflow tracts with confidence, can help to increase prenatal detection of major cardiac defects.