Detection Rate Of Congenital Heart Disease Research Articles

Pulse oximetry newborn screening for congenital heart defects. Is it really useful?

Congenital heart diseases (CHDs) are the most common birth defects, occurring in 8–9/1,000 live births and they represent one of the leading cause of infant death in the developed countries. A timely diagnosis is beneficial as even most critical cases can be successfully repaired by cardiac surgery or interventional catheterization procedures or may undergo a satisfactory palliation. Conversely, a delayed diagnosis may expose patients to the detrimental effects of prolonged hypoxia or hypoperfusion, worsen the preoperative condition and ultimately increase the risk of death or neurological sequelae [1]. With the advances in prenatal care many cases of CHDs are nowadays detected before birth. Nevertheless, the effectiveness of antenatal ultrasound screening is still not optimal and the detection rate of CHDs currently does not exceed 70% in the best case series.

Three-dimensional ultrasound STIC-HDlive rendering: new technique to assessing of fetal heart

Congenital heart diseases (CHD) are the most common fetal congenital malformations, corresponding to an inci-dence six higher than chromosome anomalies and four high -er than neural tube defects [1]. The prevalence of CHD in newborns ranges from 0.6% to 5% [2]. It’s too known that the prenatal diagnosis can modify the outcome of some types of CHD [3,4]. The two-dimensional echocardiography is the “gold standard” exam to the diagnosis of CHD; however, it is operator-depending and only is realized in high risk preg-nancies [5]. Although, the majority of CHD cases occurring in low risk pregnancies [6], being necessary appropriate screening in the second trimester ultrasound scan.Due the high incidence of CDH in low risk pregnancies, several international associations tried to incorporate the “ex -tended basic” cardiac scan in the second trimester ultrasound exam. In other words, the “extended basic” would be the in-clusion of ventricles outflows in the four chamber view [7,8]. The incorporation of medical ultrasound obstetrics educa-tion has proved to be an effective method to improve the de-tection rate of CHD [9]. Despite of these improvements in the fetal cardiac screening, the second trimester ultrasound scan continues being operator-depending and time-consuming.In the begging of 2000, a new software named spatio-tem -poral image correlation (STIC) has been available in sever-al three-dimensional ultrasound machines. STIC enables acquisition of fetal heart volume and vascular connection data. The images generated by this software can be evaluated both in multiplanar and in rendering modes. They can also be evaluated both statically and in movement (4D) through a cineloop sequence that simulates an entire cardiac cycle [10,11]. The advantages of STIC for fetal heart evaluation are the following: lower dependency on the operator’s experience, in obtaining diagnostic planes; shorter time taken to perform the examination, without the patient’s presence during the volume analysis; possibility of evaluating structures through the render mode with assessment of their morphology and function [12]; and the capacity to send volumes for analysis at other fetal cardiology reference centers via an internet link [13]. Nowadays, the STIC has been utilized in the rendering mode to assess the atrioventricular valves [14,15]and inter-ventricular septum [16]. STIC and virtual-organ comput-er-aided analysis (VOCAL) has been used to assess the fetal cardiac function by means heart stroke, cardiac output and ejection fraction [17,18]. In relation to screening of CHD, the isolated use of STIC still remains controversial. Some studies have shown advantages of two-echocardiography under STIC in the screening of CHD [19,20]; however, one study showed a great accuracy of STIC in the diagnosis of CHD in a high risk pregnancies [21]. Its necessary new multicenter studies with large samples both low and high risk obtaining definitive results [22].Recently, a new software named HD

Antenatal detection rate of major fetal cardiac abnormalities at a UK teaching hospital 2006-2009

BackgroundAntenatal detection rates of major congenital heart disease (CHD) are still relatively low a cross the UK (approx. 23% in 1999 and are estimated to be around 30% in 2009,...

Évolution du diagnostic anténatal des cardiopathies congénitales entre 1991 et 2005 dans une population limitée au département d’Indre-et-Loire

The value of prenatal diagnosis of major congenital heart diseases (CHDs) has already been proved. In this study, we observed the evolution of the detection rate of CHDs and the quality of the diagnoses over a 15-year period in the Indre-et-Loire department of France. Retrospective analysis of the quantitative and qualitative data of prenatal diagnosis between 2000 and 2005 (period 3) and comparison with studies conducted from 1991 to 1994 (period 1) and from 1995 to 1999 (period 2). The CHDs considered to be detectable are the major CHDs with neonatal symptoms. In order to analyze the quality of prenatal diagnosis, each diagnosis was classified as correct, false, or incomplete during period 3. Period 3: 65.7% detectable CHDs were screened. Using period 1 criteria for prenatal diagnosis, the percentage of CHDs detected for periods 1, 2, and 3 was 43.2, 66.7, and 78%, respectively. Between periods 2 and 3, the detection rate increased from 52 to 74% for CHDs diagnosed with the visualization of the outflow tract. It increased from 63 to 71% for CHDs diagnosed with a four-chamber view. During period 3, diagnoses made by a pediatric cardiologist were correct and complete in 80% of cases. It was less than 25% otherwise. The improvement of prenatal diagnosis over time results from technological progress, the greater experience of ultrasonographers, and the systematic visualization of the outflow tract in addition to the four-chamber view. Despite the improvement in prenatal diagnosis, one-third of major CHDs were not screened before birth. Pediatricians still need to diagnose CHDs after birth.

Population‐based study of antenatal detection of congenital heart disease by ultrasound examination

Ultrasound-based screening is widely employed for the detection of congenital malformations in utero including congenital heart disease (CHD), but there is widespread variability in the efficacy of screening programs. We aimed to evaluate current antenatal detection rates of selected congenital heart defects in Victoria. Data were collected from the Victorian Perinatal Data Collection Unit and Birth Defects Registry. There were 631 209 births in Victoria (1993-2002), of which 4897 cases had CHD. Cases included live births, stillbirths and termination of pregnancies because of CHD. We reviewed all cases from 1999 to 2002 with atrioventricular septal defect, simple coarctation of the aorta, double-inlet or -outlet ventricle, hypoplastic left heart syndrome, simple transposition of the great arteries (TGA), tetralogy of Fallot and truncus arteriosus. Outcome measures were antenatal diagnosis, pregnancy outcome and associated malformations. The overall birth prevalence of CHD from 1993 to 2002 in Victoria was 7.8/1000. The antenatal detection rate for the seven selected defects from 1999 to 2002 was 52.8%. All but 4.8% of the cases had an ultrasound examination at > 13 weeks' gestation. Antenatal detection was highest for hypoplastic left heart syndrome (84.6%) and lowest for simple TGA (17.0%). This study shows wide variation in the antenatal detection rate of CHD in Victoria. The low antenatal detection rate of TGA, a defect that should be detected easily, demonstrates suboptimal routine obstetric anomaly scanning.

Screening the fetal heart

Screening the fetal heart

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

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.

Major congenital heart disease in Northern Norway: shortcomings of pre‐ and postnatal diagnosis

Congenital heart disease (CHD) is a significant cause of perinatal mortality and morbidity worldwide. Prenatal detection rate of CHD remains low in most European countries and a substantial proportion of infants with serious heart disease are diagnosed only after discharge from hospital after birth. Earlier recognition of treatable abnormalities may improve the perinatal outcome. The purpose of this study was to evaluate the incidence, pre- and postnatal diagnosis and outcome of major CHD in two northern-most counties of Norway. All cases of major CHD were identified by reviewing the records of all fetal and neonatal echocardiographies and all perinatal autopsies performed during the study period. Data were obtained on maternal age, associated risk factors, time of diagnosis, type of CHD and outcome. Ninety-one fetal and 52 neonatal echocardiographies and 77 perinatal autopsies were performed during the 2-year study period. There was a total of 5658 births during this period. Twenty-five cases of major CHD were identified. Six of them were diagnosed prenatally, 18 after birth, and one additional case was identified from the perinatal autopsy register. The incidence of major CHD in Northern Norway was 4.4 per 1000 births. The prenatal detection rate was 24% (6/25). In 39% (7/18) of cases diagnosed postnatally the diagnosis was made following a second admission after the baby has been initially discharged from hospital after birth. The mortality among liveborn infants with major CHD was 17.4% (4/23). Despite almost universal prenatal ultrasound screening and at least one neonatal examination before discharge, the diagnosis of major CHD is made after a relevant delay in a substantial proportion of cases.

Major congenital heart disease in Northern Norway: shortcomings of pre- and postnatal diagnosis

Background. Congenital heart disease (CHD) is a significant cause of perinatal mortality and morbidity worldwide. Prenatal detection rate of CHD remains low in most European countries and a substantial proportion of infants with serious heart disease are diagnosed only after discharge from hospital after birth. Earlier recognition of treatable abnormalities may improve the perinatal outcome. The purpose of this study was to evaluate the incidence, pre- and postnatal diagnosis and outcome of major CHD in two northern-most counties of Norway. Materials and methods. All cases of major CHD were identified by reviewing the records of all fetal and neonatal echocardiographies and all perinatal autopsies performed during the study period. Data were obtained on maternal age, associated risk factors, time of diagnosis, type of CHD and outcome. Results. Ninety-one fetal and 52 neonatal echocardiographies and 77 perinatal autopsies were performed during the 2-year study period. There was a total of 5658 births during this period. Twenty-five cases of major CHD were identified. Six of them were diagnosed prenatally, 18 after birth, and one additional case was identified from the perinatal autopsy register. The incidence of major CHD in Northern Norway was 4.4 per 1000 births. The prenatal detection rate was 24% (6/25). In 39% (7/18) of cases diagnosed postnatally the diagnosis was made following a second admission after the baby has been initially discharged from hospital after birth. The mortality among liveborn infants with major CHD was 17.4% (4/23). Conclusion. Despite almost universal prenatal ultrasound screening and at least one neonatal examination before discharge, the diagnosis of major CHD is made after a relevant delay in a substantial proportion of cases.

Evaluation and evolution during time of prenatal diagnosis of congenital heart diseases by routine fetal ultrasonographic examination

The objectives of this study were to evaluate routine prenatal diagnosis of congenital heart diseases (CHD) by fetal ultrasound examination in a well-defined population during the period 1994–1999 and to compare these results with the results from 1979 to 1993. This study included 80 076 consecutive pregnancies of known ouome from 1994 to 1999. CHD were classified as isolated or associated when at least one other major extra-cardiac malformation was present. Only 137 out of 688 malformed fetuses with CHD without chromosomal anomalies were detected (19.9%). The sensitivity of detection varied from 61.9% for malformations such as isolated hypoplastic left heart and single ventricle, to around 7–19% for atrial and ventricular septal defects. Prenatal detection rate of CHD was 11.4% for isolated cases, and 40.2% for multiple malformed with CHD. The gestational age at discovery varied from 16 to 36 weeks. There is no upper limit for termination of pregnancies in our country; 12.3% of all pregnancies were terminated after prenatal diagnosis. However, 62% of the pregnancies with a CHD detected prenatally were terminated. The detection rate of CHD increased during time from 9.2% during the period 1979–1988 to 13.7% during the period 1990–1993 and to 19.1% during the period 1994–1999. Our study shows large variation in the prenatal detection rate of CHD. Prenatal diagnosis of CHD is significantly higher when associated malformations are present. Cardiac defects affecting the size of the ventricles have the highest detection rate. Gestational age at discovery was 20–24 weeks for the majority of associated cardiac defects. The prenatal detection rate of CHD increased during time from 1979 to 1999.