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Diagnosis of congenital heart disease in an era of universal prenatal ultrasound screening in southwest Ohio

Published online by Cambridge University Press:  10 October 2013

Priya Sekar ,
Haleh C. Heydarian ,
James F. Cnota ,
Lisa K. Hornberger  and
Erik C. Michelfelder
Priya Sekar*
Affiliation:
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Division of Pediatric Cardiology, The Heart Institute, Cincinnati, Ohio, United States of America Department of Pediatrics, Division of Pediatric Cardiology, The Johns Hopkins Hospital, Baltimore, Maryland, United States of America
Haleh C. Heydarian
Affiliation:
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Division of Pediatric Cardiology, The Heart Institute, Cincinnati, Ohio, United States of America
James F. Cnota
Affiliation:
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Division of Pediatric Cardiology, The Heart Institute, Cincinnati, Ohio, United States of America
Lisa K. Hornberger
Affiliation:
Departments of Pediatrics, Division of Pediatric Cardiology and Obstetrics and Gynecology, Fetal & Neonatal Cardiology Program, University of Alberta, Edmonton, Alberta, Canada
Erik C. Michelfelder
Affiliation:
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Division of Pediatric Cardiology, The Heart Institute, Cincinnati, Ohio, United States of America
*
Correspondence to: Dr P. Sekar, MD MPH, Department of Pediatrics, Division of Pediatric Cardiology, Bloomberg Children's Center, Johns Hopkins Hospital, M2303, 1800 Orleans Street, Baltimore, MD 21287, United States of America. Tel: +443 682 0529; Fax: +410 955 0897; E-mail: psekar1@jhmi.edu
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Abstract

Objectives

Diagnostic ultrasound is widespread in obstetric practice, yet many babies with major congenital heart disease remain undiagnosed. Factors affecting prenatal diagnosis of major congenital heart disease are not well understood. This study aims to document prenatal detection rates for major congenital heart disease in the Greater Cincinnati area, and identify factors associated with lack of prenatal diagnosis.

Methods

All living infants diagnosed with major congenital heart disease by 4 months of age at our centre were prospectively identified. Prenatal care data were obtained by parent interview. Neonatal records were reviewed for postnatal data. Obstetricians were contacted for diagnostic ultrasound data.

Results

A total of 100 infants met the inclusion criteria. In all, 95 infants were analysed, of whom 94 were offered diagnostic ultrasound. In all, 41 had a prenatal diagnosis of major congenital heart disease. The rate of prenatal detection varied by cardiac lesion, with aortic arch abnormalities, semilunar valve abnormalities, and venous anomalies going undetected in this sample. Among subjects without prenatal detection, the highest proportion consisted of those having Level 1 diagnostic ultrasound only (66%). Prenatal detection was not significantly influenced by maternal race, education level, income, or insurance type.

Conclusions

Despite nearly universal diagnostic ultrasound, detection rates of major congenital heart disease remain low in southwest Ohio. An educational outreach programme including outflow tract sweeps for community-level obstetrical personnel may improve detection rates.

Keywords

Screeningultrasoundcongenital heart disease
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 1 , January 2015 , pp. 35 - 41
Copyright
Copyright © Cambridge University Press 2013 

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References

1. Rodney, WM. More on the use of ultrasonography in the emergency department. West J Med 1995; 163: 393–394.Google ScholarPubMed
2. Ewigman, BG, Crane, JP, Frigoletto, FD, et al. Effect of prenatal ultrasound screening on perinatal outcome. RADIUS Study Group. N Engl J Med 1993; 329: 821–827.Google Scholar
3. Chitty, LS, Hunt, GH, Moore, J, et al. Effectiveness of routine ultrasonography in detecting fetal structural abnormalities in a low risk population. BMJ 1991; 303: 1165–1169.CrossRefGoogle Scholar
4. Grandjean, H, Larroque, D, Levi, S. The performance of routine ultrasonographic screening of pregnancies in the Eurofetus Study. Am J Obstet Gynecol 1999; 181: 446–454.Google Scholar
5. Levi, S. Ultrasound in prenatal diagnosis: polemics around routine ultrasound screening for second trimester fetal malformations. Prenat Diagn 2002; 22: 285–295.Google Scholar
6. Levi, S, Hyjazi, Y. Sensitivity of routine ultrasonographic screening for congenital anomalies during the last 5 years. J Ultrasound Med 1992; 11: 188.CrossRefGoogle ScholarPubMed
7. Randall, P, Brealey, S, Hahn, S, et al. Accuracy of fetal echocardiography in the routine detection of congenital heart disease among unselected and low risk populations: a systematic review. BJOG 2005; 112: 24–30.Google Scholar
8. Gembruch, U. Prenatal diagnosis of congenital heart disease. Prenat Diagn 1997; 17: 1283–1298.Google Scholar
9. Ferencz, C, Rubin, JD, McCarter, RJ, et al. Congenital heart disease: prevalence at livebirth. The Baltimore-Washington Infant Study. Am J Epidemiol 1985; 121: 31–36.CrossRefGoogle ScholarPubMed
10. Meberg, A, Otterstad, JE, Froland, G, et al. Outcome of congenital heart defects – a population-based study. Acta Paediatr 2000; 89: 1344–1351.Google Scholar
11. Cullen, S, Sharland, GK, Allan, LD, et al. Potential impact of population screening for prenatal diagnosis of congenital heart disease. Arch Dis Child 1992; 67: 775–778.Google Scholar
12. Gottliebson, WM, Border, WL, Franklin, CM, et al. Accuracy of fetal echocardiography: a cardiac segment-specific analysis. Ultrasound Obstet Gynecol 2006; 28: 15–21.Google Scholar
13. Friedberg, MK, Silverman, NH, Moon-Grady, AJ, et al. Prenatal detection of congenital heart disease. J Pediatr 2009; 155: 26–31; 31 e1.Google Scholar
14. Montana, E, Khoury, MJ, Cragan, JD, et al. Trends and outcomes after prenatal diagnosis of congenital cardiac malformations by fetal echocardiography in a well defined birth population, Atlanta, Georgia, 1990-1994. J Am Coll Cardiol 1996; 28: 1805–1809.CrossRefGoogle Scholar
15. Jaeggi, ET, Sholler, GF, Jones, OD, et al. Comparative analysis of pattern, management and outcome of pre- versus postnatally diagnosed major congenital heart disease: a population-based study. Ultrasound Obstet Gynecol 2001; 17: 380–385.CrossRefGoogle ScholarPubMed
16. Gilboa, SM, Salemi, JL, Nembhard, WN, et al. Mortality resulting from congenital heart disease among children and adults in the United States, 1999 to 2006. Circulation 2010; 122: 2254–2263.Google Scholar
17. Verheijen, PM, Lisowski, LA, Stoutenbeek, P, et al. Prenatal diagnosis of congenital heart disease affects preoperative acidosis in the newborn patient. J Thorac Cardiovasc Surg 2001; 121: 798–803.Google Scholar
18. Brick, DH, Allan, LD. Outcome of prenatally diagnosed congenital heart disease: an update. Pediatr Cardiol 2002; 23: 449–453.Google Scholar
19. Tworetzky, W, McElhinney, DB, Reddy, VM, et al. Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome. Circulation 2001; 103: 1269–1273.Google Scholar
20. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 101: Ultrasonography in pregnancy. Obstet Gynecol 2009; 113 (Pt 1): 451–461.CrossRefGoogle Scholar
21. Acherman, RJ, Evans, WN, Luna, CF, et al. Prenatal detection of congenital heart disease in southern Nevada: the need for universal fetal cardiac evaluation. J Ultrasound Med 2007; 26: 1715,9; quiz 1720-1.Google Scholar
22. Bromley, B, Estroff, JA, Sanders, SP, et al. Fetal echocardiography: accuracy and limitations in a population at high and low risk for heart defects. Am J Obstet Gynecol 1992; 166: 1473–1481.CrossRefGoogle Scholar
23. Hunter, S, Heads, A, Wyllie, J, et al. Prenatal diagnosis of congenital heart disease in the northern region of England: benefits of a training programme for obstetric ultrasonographers. Heart 2000; 84: 294–298.CrossRefGoogle ScholarPubMed
24. Todros, T, Faggiano, F, Chiappa, E, et al. Accuracy of routine ultrasonography in screening heart disease prenatally. Gruppo Piemontese for prenatal screening of congenital heart disease. Prenat Diagn 1997; 17: 901–906.Google Scholar
25. Carvalho, JS, Mavrides, E, Shinebourne, EA, et al. Improving the effectiveness of routine prenatal screening for major congenital heart defects. Heart 2002; 88: 387–391.CrossRefGoogle ScholarPubMed
26. Sklansky, MS, Berman, DP, Pruetz, JD, et al. Prenatal screening for major congenital heart disease: superiority of outflow tracts over the 4-chamber view. J Ultrasound Med 2009; 28: 889–899.Google Scholar
27. Copel, JA, Tan, AS, Kleinman, CS. Does a prenatal diagnosis of congenital heart disease alter short-term outcome? Ultrasound Obstet Gynecol 1997; 10: 237–241.Google Scholar
28. Fesslova’, V, Nava, S, Villa, L. Evolution and long term outcome in cases with fetal diagnosis of congenital heart disease: Italian multicentre study. Fetal Cardiology Study Group of the Italian Society of Pediatric Cardiology. Heart 1999; 82: 594–599.Google Scholar
29. Dresang, LT, Rodney, WM, Rodney, KM. Prenatal ultrasound: a tale of two cities. J Natl Med Assoc 2006; 98: 167–171.Google Scholar
30. Connor, PD, Deutchman, ME, Hahn, RG. Training in obstetric sonography in family medicine residency programs: results of a nationwide survey and suggestions for a teaching strategy. J Am Board Fam Pract 1994; 7: 124–129.Google Scholar
31. Smulian, JC, Vintzileos, AM, Rodis, JF, et al. Community-based obstetrical ultrasound reports: documentation of compliance with suggested minimum standards. J Clin Ultrasound 1996; 24: 123–127.Google Scholar
32. Franklin, O, Burch, M, Manning, N, et al. Prenatal diagnosis of coarctation of the aorta improves survival and reduces morbidity. Heart 2002; 87: 67–69.Google Scholar
33. Bonnet, D, Coltri, A, Butera, G, et al. Detection of transposition of the great arteries in fetuses reduces neonatal morbidity and mortality. Circulation 1999; 99: 916–918.Google Scholar
34. Garne, E. Prenatal diagnosis of six major cardiac malformations in Europe – a population based study. Acta Obstet Gynecol Scand 2001; 80: 224–228.Google Scholar
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