Prenatal Detection of Congenital Heart Disease: Identification of High Risk Groups and Normal Sonographic Appearances

BMUS Bulletin ◽  
2002 ◽  
Vol 10 (1) ◽  
pp. 6-10
Author(s):  
Annette Jones ◽  
Andrew Cook ◽  
John Simpson
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
High Risk ◽  
Congenital Heart ◽  
Risk Groups ◽  
Prenatal Detection ◽  
Disease Identification

Stage-1 Hybrid Palliation for High-Risk 2-Ventricle Patients with Ductal-Dependent Systemic Circulation in the Era of High Prenatal Detection

2021 ◽  
Vol 12 (6) ◽  
pp. 754-759
Author(s):  
William N. Evans ◽  
Ruben J. Acherman ◽  
Michael L. Ciccolo ◽  
Juan Lehoux ◽  
Alvaro Galindo ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
High Risk ◽  
Congenital Heart ◽  
Systemic Circulation ◽  
Complex Congenital Heart Disease ◽  
Prenatal Detection ◽  
Bilateral Pulmonary Artery Banding ◽  
Stage 1 ◽  
Hybrid Palliation

Objective We reviewed our center's prenatal detection and surgical experience with high-risk, 2-ventricle patients, with complex congenital heart disease that underwent stage-1 hybrid palliation. Methods We retrospectively identified those born between March 2008 and March 2021 with 2-ventricle hearts, complex congenital cardiovascular malformations, and ductal-dependent systemic circulation that underwent stage-1 hybrid palliation consisting of surgical bilateral pulmonary artery banding and interventional catheterization placed ductus arteriosus stents. Results We identified 30 patients. Of the 30, 19 (63%) were male. For the 30, median gestational age was 35 weeks (29-39 weeks), and median birth weight was 2.2 kg (0.6-4.5 kg). Of the 30, 1 was transferred from an adjacent state, and 29 were born in Nevada. Of the 29 born in Nevada, overall statewide prenatal detection was 18 of 29 (62%); however, for 2008 to 2011 the prenatal detection rate was 3 of 10 (30%) and 15 of 19 (79%) for 2012 to 2021, P = .03. For the last 5 years, prenatal detection for Nevada-born patients was 8 of 8 (100%). Two full-term newborns, without a prenatal diagnosis, presented postnatally in extremis. For the 30 patients, there were 0 stage-1 hybrid palliation mortalities, 1 subsequent repair mortality, and 3 late nonsurgical deaths. Conclusions Stage-1 hybrid palliation may result in excellent surgical outcomes for high-risk, 2-ventricle patients. Additionally, high rates of population-wide prenatal detection are possible for high-risk congenital heart disease, allowing prenatal planning and possibly reducing postnatal extremis presentations.

Survival of Patients with High-Risk Pulmonary Arterial Hypertension Associated with Congenital Heart Disease

2021 ◽  
Vol 104 (6) ◽  
pp. 895-901
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
High Risk ◽  
Congenital Heart ◽  
First Year ◽  
Pulmonary Arterial ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: Pulmonary arterial hypertension (PAH) is a common complication of congenital heart disease (CHD) with uncorrected left-to-right shunts. Currently, no consensus guideline exists on the management of PAH-CHD in children, especially those who do not meet operability criteria. Objective: To compare survival between three groups of high-risk PAH-CHD, group 1: total correction including both surgical and percutaneous intervention, group 2: palliative treatment, and group 3: conservative with medical treatment group. Materials and Methods: All pediatric patients with PAH-CHD that underwent cardiac catheterization between January 1, 2008 and December 31, 2017 were retrospectively reviewed. Inclusion criteria were high risk PAH-CHD patients who had pulmonary vascular resistance (PVR) greater than 6 Wood unit·m² and PVR-to-SVR ratio greater than 0.3 evaluated in room air. Exclusion criteria were younger than three months of age, severe left side heart disease with pulmonary capillary wedge pressure greater than 15 mmHg, obstructive total pulmonary venous return, and single ventricle physiology. The Kaplan-Meier analysis was performed from the date of PAH diagnosis to the date of all-cause mortality or to censored date at last follow-up. Results: Seventy-six patients with a median age at diagnosis of 27.5 months (IQR 14.5 to 69.0 months) were included in this study. The patients were divided into three subgroups and included 38 patients (50.0%) in group 1, six patients (7.9%) in group 2, and 32 patients (42.1%) in group 3. The median follow-up time was 554 days (IQR 103 to 2,133 days). The overall mortality was 21.7%. One-year survival in patients with simple lesion in group 1 and 3 were 79.5% and 87.5% and patients with complex lesions in group 1, 2, and 3 were 93.8%, 83.3%, and 73.1%, respectively. The results showed that most mortalities occurred in the first year. There were no statistically significant differences in survival among difference types of treatment (log rank test, p=0.522). Conclusion: The mortality of high-risk PAH-CHD patients were not different among those who underwent corrective surgery, palliative, or conservative treatment. The mortality was high in the first year after PAH diagnosis and remain stable afterward. Management decision for an individual with high-risk PAH-CHD patients requires comprehensive clinical assessment to balance the risks and benefits before making individualized clinical judgment. Keywords: Pulmonary hypertension; Congenital heart disease; High-risk patients

Contraception and pregnancy

2011 ◽  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
High Risk ◽  
General Population ◽  
Congenital Heart ◽  
Post Partum ◽  
Maternal Risk ◽  
Risk Of Death ◽  
Pregnancy And Delivery

Introduction 208General principles 208Contraception 210Preconception 214Pregnancy and delivery 218Post-partum 220Heart disease is the largest single cause of maternal death in the UK4. The number and complexity of survivors of congenital heart disease well enough to consider pregnancy is growing. The maternal risk amongst this population varies from being no different to that of the general population, to carrying a high risk of long-term morbidity and >40% risk of death....

The association between feeding protocol compliance and weight gain following high-risk neonatal cardiac surgery

2019 ◽  
Vol 29 (5) ◽  
pp. 594-601 ◽  
Author(s):  
Jamie M. Furlong-Dillard ◽  
Benjamin J. Miller ◽  
Kathy A. Sward ◽  
Alaina I. Neary ◽  
Trudy L. Hardin-Reynolds ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Weight Gain ◽  
High Risk ◽  
Congenital Heart ◽  
Clinical Severity ◽  
Z Score ◽  
Protocol Adherence ◽  
Feeding Protocol ◽  
Weight For Age

AbstractBackground:Children with congenital heart disease are at high risk for malnutrition. Standardisation of feeding protocols has shown promise in decreasing some of this risk. With little standardisation between institutions’ feeding protocols and no understanding of protocol adherence, it is important to analyse the efficacy of individual aspects of the protocols.Methods:Adherence to and deviation from a feeding protocol in high-risk congenital heart disease patients between December 2015 and March 2017 were analysed. Associations between adherence to and deviation from the protocol and clinical outcomes were also assessed. The primary outcome was change in weight-for-age z score between time intervals.Results:Increased adherence to and decreased deviation from individual instructions of a feeding protocol improves patients change in weight-for-age z score between birth and hospital discharge (p = 0.031). Secondary outcomes such as markers of clinical severity and nutritional delivery were not statistically different between groups with high or low adherence or deviation rates.Conclusions:High-risk feeding protocol adherence and fewer deviations are associated with weight gain independent of their influence on nutritional delivery and caloric intake. Future studies assessing the efficacy of feeding protocols should include the measures of adherence and deviations that are not merely limited to caloric delivery and illness severity.

High-Risk Reoperative Sternotomy—How We Do It, How We Teach It

2020 ◽  
Vol 11 (4) ◽  
pp. 459-465
Author(s):  
Siddharth Pahwa ◽  
Elizabeth H. Stephens ◽  
Joseph A. Dearani
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
High Risk ◽  
Congenital Heart ◽  
Preoperative Evaluation ◽  
Cardiac Injury ◽  
Insight Into ◽  
Level Of Risk

With the increasing number of congenital heart disease patients living into adulthood and requiring reoperations, learning a safe and efficient reoperative sternotomy is essential. This article provides insight into the successful reoperative sternotomy, including preoperative evaluation, assessing risk for cardiac injury and preparations to take depending on the level of risk, safeguards taken before and during the sternotomy, and pearls and pitfalls in managing untoward events.

A Simple Effective Protocol to Increase Prenatal Detection of Critical Congenital Heart Disease

2013 ◽  
Vol 30 (2) ◽  
pp. 60-66 ◽  
Author(s):  
Karen M. Letourneau ◽  
Keith McDonald ◽  
Reeni Soni ◽  
Fern Karlicki ◽  
David Horne ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Critical Congenital Heart Disease ◽  
Prenatal Detection
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