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Ramcharan T, Quintero DB, Stickley J, Poole E, Miller P, Desai T, Harris M, Kilby MD, Stumper O, Khan N, Barron DJ, Seale AN. Medium-term Outcome of Prenatally Diagnosed Hypoplastic Left-Heart Syndrome and Impact of a Restrictive Atrial Septum Diagnosed in-utero. Pediatr Cardiol 2023:10.1007/s00246-023-03184-z. [PMID: 37219587 DOI: 10.1007/s00246-023-03184-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/12/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Surgical outcome data differs from overall outcomes of prenatally diagnosed fetuses with hypoplastic left heart syndrome (HLHS). Our aim was to describe outcome of prenatally diagnosed fetuses with this anomaly. METHODS Retrospective review of prenatally diagnosed classical HLHS at a tertiary hospital over a 13-year period, estimated due dates 01/08/2006 to 31/12/2019. HLHS-variants and ventricular disproportion were excluded. RESULTS 203 fetuses were identified with outcome information available for 201. There were extra-cardiac abnormalities in 8% (16/203), with genetic variants in 14% of those tested (17/122). There were 55 (27%) terminations of pregnancy, 5 (2%) intrauterine deaths and 10 (5%) babies had prenatally planned compassionate care. There was intention to treat (ITT) in the remaining 131/201(65%). Of these, there were 8 neonatal deaths before intervention, two patients had surgery in other centers. Of the other 121 patients, Norwood procedure performed in 113 (93%), initial hybrid in 7 (6%), and 1 had palliative coarctation stenting. Survival for the ITT group from birth at 6-months, 1-year and 5-years was 70%, 65%, 62% respectively. Altogether of the initial 201 prenatally diagnosed fetuses, 80 patients (40%) are currently alive. A restrictive atrial septum (RAS) is an important sub-category associated with death, HR 2.61, 95%CI 1.34-5.05, p = 0.005, with only 5/29 patients still alive. CONCLUSION Medium-term outcomes of prenatally diagnosed HLHS have improved however it should be noted that almost 40% do not get to surgical palliation, which is vital to those doing fetal counselling. There remains significant mortality particularly in fetuses with in-utero diagnosed RAS.
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Affiliation(s)
- Tristan Ramcharan
- Heart Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Diana B Quintero
- Heart Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - John Stickley
- Heart Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Esther Poole
- Heart Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Paul Miller
- Heart Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Tarak Desai
- Heart Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Michael Harris
- Heart Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Mark D Kilby
- Fetal Medicine Centre, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Medical Genomics Research Group, Granta Park, Illumina, Cambridge, UK
| | - Oliver Stumper
- Heart Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Natasha Khan
- Heart Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - David J Barron
- Heart Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Anna N Seale
- Heart Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
- Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
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Wójtowicz A, Ochoda-Mazur A, Mroczek T, Huras H, Włoch A. Near-Term Cerebroplacental Doppler, Heart Morphology, and Neonatal Biometry in Hypoplastic Left Heart Syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2087-2096. [PMID: 34842288 DOI: 10.1002/jum.15893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To analyze near-term cerebroplacental Doppler, heart morphology, and neonatal biometry in isolated hypoplastic left heart syndrome (HLHS) relative to healthy controls. METHODS This retrospective study included 55 fetuses with HLHS (29 with mitral valve stenosis [MS]/aortic valve atresia [AA], 14 with MS/aortic valve stenosis, and 12 with mitral valve atresia [MA]/[AA]) diagnosed prenatally between 2010 and 2019 at 2 referral centers and 101 healthy controls. Ultrasound assessment included umbilical artery (UA), middle cerebral artery (MCA) pulsatility index (PI), and cerebroplacental ratio (CPR), with neonatal weight, length, head circumference (HC), Apgar score, and UA pH measured at birth. RESULTS In total, 32.7% of HLHS fetuses had abnormal MCA-PI and UA-PI, and 38.2% had CPRs below the fifth percentile before birth. All tested Doppler parameters differed from those of the healthy controls (P ≤ .01). Birth weight and length were comparable between HLHS and control fetuses, whereas birth HCs were smaller in the HLHS group than in the control group (P = .018). In both groups, increased UA-PI correlated with lower birth weight, but only HLHS fetuses with UA-PI > the 95th percentile had a lower median HC at birth than those with normal UA-PI (P = .045). The median UA-PI percentile was higher in fetuses with MA than in fetuses with MS (P = .015). The ascending aortic diameter correlated with birth weight (P = .036) and birth length (P = .039). CONCLUSION Abnormal cerebroplacental hemodynamics are evident in a high percentage of near-term fetuses with HLHS, and increased placental resistance may contribute to birth weight and HC. Moreover, heart morphology may impact placental circulation and neonatal biometry.
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Affiliation(s)
- Anna Wójtowicz
- Department of Obstetrics and Perinatology, Jagiellonian University Medical College, Kraków, Poland
| | | | - Tomasz Mroczek
- Department of Pediatric Cardiac Surgery, Polish-American Children's Hospital, Jagiellonian University Medical College, Kraków, Poland
| | - Hubert Huras
- Department of Obstetrics and Perinatology, Jagiellonian University Medical College, Kraków, Poland
| | - Agata Włoch
- Department of Obstetrics and Gynecology in Ruda Slaska, Medical University of Silesia, Ruda Śląska, Poland
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