Results of early foetal echocardiography and cumulative detection rate of congenital heart disease

2011 ◽  
Vol 21 (5) ◽  
pp. 505-517 ◽  
Author(s):  
David R. Hartge ◽  
Jan Weichert ◽  
Martin Krapp ◽  
Ute Germer ◽  
Ulrich Gembruch ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Detection Rate ◽  
Congenital Heart ◽  
Neonatal Period ◽  
First Trimester ◽  
Third Trimester ◽  
Detection Rates ◽  
Cardiac Pathology ◽  
Singleton Pregnancies

AbstractObjectiveThe aim of this study is to evaluate the cumulative detection rate of foetal echocardiography during gestation and in the early neonatal period, with a special emphasis on early foetal echocardiography.MethodsWe conducted a retrospective survey of all singleton pregnancies from 1993 to 2007, with complete sequential echocardiography from 11 plus 0 to 13 plus 6 weeks of gestation. It was mandatory to have at least one foetal echocardiography in the second or third trimester and one postnatally.ResultsOur study included 3521 pregnancies, in which 77 cases were diagnosed with congenital heart disease. Of them, 66 were detected in the first trimester – 11 plus 0 to 11 plus 6 weeks: 22 cases; 12 plus 0 to 12 plus 6 weeks: 23 cases; 13 plus 0 to 13 plus 6 weeks: 21 cases – with an 85.7% detection rate of congenital heart disease in early foetal echocardiography. In the second trimester, seven cases were found, with a detection rate of 9.1%. The third trimester reported two cases, with a detection rate of 2.6%. Postnatally, two (2.6%) cases were detected. The overall in utero detection rate of congenital heart disease was 97.4%.ConclusionsFoetal echocardiography performed at the time of anomaly screening in the first trimester results in high detection rates of congenital heart disease. Cardiac pathology may evolve, and further examinations at later stages of pregnancy could improve the detection rate of congenital heart disease.

scholarly journals Training: improving antenatal detection and outcomes of congenital heart disease

2018 ◽  
Vol 7 (4) ◽  
pp. e000276 ◽  
Author(s):  
Orhan Uzun ◽  
Julia Kennedy ◽  
Colin Davies ◽  
Anthony Goodwin ◽  
Nerys Thomas ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Detection Rate ◽  
Congenital Heart ◽  
Training Programme ◽  
Referral Rate ◽  
Cardiac Anomaly ◽  
Cardiac Ultrasound ◽  
Detection Rates ◽  
Antenatal Detection ◽  
The Uk

ObjectivesThis study describes the design, delivery and efficacy of a regional fetal cardiac ultrasound training programme. This programme aimed to improve the antenatal detection of congenital heart disease (CHD) and its effect on fetal and postnatal outcomes.Design setting and participantsThis was a prospective study that compared antenatal CHD detection rates by professionals from 13 hospitals in Wales before and after engaging in our ‘skills development programme’. Existing fetal cardiac practice and perinatal outcomes were continuously audited and progressive targets were set. The work was undertaken by the Welsh Fetal Cardiovascular Network, Antenatal Screening Wales (ASW), a superintendent sonographer and a fetal cardiologist.InterventionsA core professional network was established, engaging all stakeholders (including patients, health boards, specialist commissioners, ASW, ultrasonographers, radiologists, obstetricians, midwives and paediatricians). A cardiac educational lead (midwife, superintendent sonographer, radiologist, obstetrician, or a fetal medicine specialist) was established in each hospital. A new cardiac anomaly screening protocol (‘outflow tract view’) was created and training on the new protocol was systematically delivered at each centre. Data were prospectively collected and outcomes were continuously audited: locally by the lead fetal cardiologist; regionally by the Congenital Anomaly Register and Information Service in Wales; and nationally by the National Institute for Cardiac Outcomes and Research (NICOR) in the UK.Main outcome measuresPatient satisfaction; improvements in individual sonographer skills, confidence and competency; true positive referral rate; local hospital detection rate; national detection rate of CHD; clinical outcomes of selected cardiac abnormalities; reduction of geographical health inequality; cost efficacy.ResultsHigh levels of patient satisfaction were demonstrated and the professional skill mix in each centre was improved. The confidence and competency of sonographers was enhanced. Each centre demonstrated a reduction in the false-positive referral rate and a significant increase in cardiac anomaly detection rate. According to the latest NICOR data, since implementing the new training programme Wales has sustained its status as UK lead for CHD detection. Health outcomes of children with CHD have improved, especially in cases of transposition of the great arteries (for which no perinatal mortality has been reported since 2008). Standardised care led to reduction of geographical health inequalities with substantial cost saving to the National Health Service due to reduced false-positive referral rates. Our successful model has been adopted by other fetal anomaly screening programmes in the UK.ConclusionsAntenatal cardiac ultrasound mass training programmes can be delivered effectively with minimal impact on finite healthcare resources. Sustainably high CHD detection rates can only be achieved by empowering the regional screening workforce through continuous investment in lifelong learning activities. These should be underpinned by high quality service standards, effective care pathways, and robust clinical governance and audit practices.

Generalized Bone Changes and Thrombocytopenic Purpura in Association with Intrauterine Rubella

PEDIATRICS ◽  
1965 ◽  
Vol 36 (2) ◽  
pp. 264-268
Author(s):  
AARON R. RAUSEN ◽  
ROBERT D. LONDON ◽  
ABRAHAM MIZRAHI ◽  
LOUIS Z. COOPER
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Rubella Virus ◽  
Congenital Heart ◽  
Newborn Infants ◽  
First Trimester ◽  
Long Bones ◽  
Thrombocytopenic Purpura ◽  
Bone Changes ◽  
First Trimester Of Pregnancy

Two newborn infants are presented whose mothers had rubella in the first trimester of pregnancy. Both infants were born with thrombocytopenic purpura and suggestive evidence of a hemolytic disorder. The second infant had congenital heart disease as well. Roentgenographic changes in the metaphyseal ends of several long bones, observed in the first infant at 3 days of age, regressed completely by 2 months of age. The second infant had roentgenographic evidence of metaphyseal changes of a lesser degree, limited to the distal ends of the femora. These changes were no longer present at 6 weeks of age. Both infants were shown to be harboring an interfering agent with the characteristics of the rubella virus.

Cardiac pathology

2017 ◽  
Author(s):  
James Carton
Keyword(s):  
Myocardial Infarction ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Left Ventricular ◽  
Right Ventricular Failure ◽  
St Elevation Myocardial Infarction ◽  
Ventricular Failure ◽  
Cardiac Pathology ◽  
St Elevation

This chapter covers cardiac pathology, including congenital heart disease (CHD), angina pectoris, unstable angina, non-ST-elevation myocardial infarction, ST-elevation myocardial infarction, left ventricular failure (LVF), right ventricular failure (RVF), valvular heart disease, cardiomyopathies, infective endocarditis, myocarditis, and pericarditis.

Congenital heart disease in the neonatal period

1964 ◽  
Vol 65 (5) ◽  
pp. 721-726 ◽  
Author(s):  
Ali Mehrizi ◽  
M.S. Hirsch ◽  
Helen B. Taussig
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Neonatal Period

scholarly journals 2076927 Is the Brain-Sparing Effect Described in Fetuses With Congenital Heart Disease Evident in the First Trimester?

2015 ◽  
Vol 41 (4) ◽  
pp. S52
Author(s):  
Reem Abu-Rustum ◽  
M. Fouad Ziade ◽  
Assaad Kesrouani ◽  
Sameer Abu-Rustum ◽  
Linda Daou
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
First Trimester ◽  
Sparing Effect ◽  
The Brain

Reversed end-diastolic umbilical flow in a first-trimester fetus with congenital heart disease

1998 ◽  
Vol 18 (10) ◽  
pp. 1001-1005 ◽  
Author(s):  
Antoni Borrell ◽  
Dolors Costa ◽  
Josep M. Martinez ◽  
M. Teresa Farre ◽  
Montserrat Palacio ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
First Trimester

scholarly journals Sonographer-Identified Barriers and Facilitators to Prenatal Screening for Congenital Heart Disease

2016 ◽  
Vol 33 (1) ◽  
pp. 3-12 ◽  
Author(s):  
Nelangi Pinto ◽  
Xiaoming Sheng ◽  
Heather T. Keenan ◽  
Janice L. B. Byrne ◽  
Belva Stanton ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Self Efficacy ◽  
Congenital Heart ◽  
Fetal Heart ◽  
Random Effect ◽  
Image Interpretation ◽  
Ultrasound Screening ◽  
Fetal Ultrasound ◽  
Detection Rates

Background: Fetal ultrasound screening for congenital heart disease has high detection rates in efficacy studies but not in practice. We investigated sonographers’ perspectives on barriers to screening and their association with intermediate measures of cardiac imaging. Methods: Barriers to fetal heart screening were identified in focus groups with obstetric sonographers. A web-based survey measured reported barriers and sonographers’ ability to interpret fetal heart screening images. Generalized linear random effect models assessed associations between barriers and image interpretation. Results: Four themes were identified: intrinsic barriers (self-efficacy), external barriers (time), informational needs, and provider and patient expectations. Among 224 sonographers surveyed, an average of 77.6% of fetal heart images were interpreted correctly. Perceptions about self-efficacy ( P = .03) and ease of performing imaging ( P = .01) were associated with accuracy of image interpretation. Conclusions: Several sonographer-identified barriers associated with image interpretation may be novel targets for improving prenatal detection of congenital heart disease.

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