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Evans WN, Acherman RJ, Ciccolo ML, Lehoux J, Rothman A, Galindo A, Restrepo H. Prenatal diagnosis of hypoplastic aortic arch without intracardiac malformations: The nevada experience. J Card Surg 2022; 37:3705-3710. [PMID: 36047366 DOI: 10.1111/jocs.16834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We reviewed our center's experience with neonatal and infant hypoplastic aortic arch, unassociated with intracardiac malformations, and investigated changes in prenatal detection rates over time for those requiring therapeutic procedures. METHODS We identified all prenatal diagnoses of hypoplastic aortic arch with situs solitus, unassociated with intracardiac malformations, made in Nevada between May 2017 and April 2022. In addition, we identified all those 0-180 days old, with prenatal care, that underwent a surgical or interventional cardiac catheterization aortic arch procedure, whether prenatally or postnatally diagnosed. We excluded those with ventricular septal defects, functionally univentricular hearts, interrupted aortic arches, or any associated malformation requiring an additional surgical or interventional procedure ≤6 months old. Additionally, we calculated prenatal detection rates for those undergoing a surgical or interventional catheterization procedure for each of the 5 years. RESULTS We identified 107 patients prenatally and postnatally. Of the 107 patients, 56 (34 prenatally diagnosed and 22 postnatally diagnosed) underwent an aortic arch procedure, and 51 additionally prenatally diagnosed, live-born infants did not undergo a procedure. Of the 56 procedures, 2 were by interventional catheterization, and 54 underwent a surgical repair. Prenatal detection for those undergoing a procedure statistically significantly increased over the 5 years from 38% to 82%, rho = 0.95 (p = .04). CONCLUSIONS Currently in Nevada, our prenatal detection rate is >80% in the general population for those between 0 and 6 months old who require a therapeutic procedure for aortic arch obstruction without intracardiac malformations.
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Affiliation(s)
- William N Evans
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Ruben J Acherman
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Michael L Ciccolo
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Juan Lehoux
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA
| | - Abraham Rothman
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Alvaro Galindo
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Humberto Restrepo
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
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2
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Krishnan R, Deal L, Chisholm C, Cortez B, Boyle A. Concordance Between Obstetric Anatomic Ultrasound and Fetal Echocardiography in Detecting Congenital Heart Disease in High-risk Pregnancies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2105-2112. [PMID: 33301225 DOI: 10.1002/jum.15592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/19/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To evaluate the concordance between second-trimester anatomic ultrasound and fetal echocardiography in detecting minor and critical congenital heart disease in pregnancies meeting American Heart Association criteria. METHODS We conducted a retrospective cohort study of pregnancies in which a second-trimester fetal anatomic ultrasound examination (18-26 weeks) and fetal echocardiography were performed between 2012 and 2018 at our institution based on American Heart Association recommendations. Anatomic ultrasound studies were interpreted by maternal-fetal medicine specialists and fetal echocardiographic studies by pediatric cardiologists. Our primary outcome was the proportion of critical congenital heart disease (CCHD) cases not detected by anatomic ultrasound but detected by fetal echocardiography. The secondary outcome was the proportion of total congenital heart disease cases missed by anatomic ultrasound but detected by fetal echocardiography. Neonatal medical records were reviewed for all pregnancies when obtained and available. RESULTS Overall, 722 studies met inclusion criteria. Anatomic ultrasound and fetal echocardiography were in agreement in detecting cardiac abnormalities in 681(96.1%) studies (κ = 0.803; P < .001). The most common diagnosis not identified by anatomic ultrasound was a ventricular septal defect, accounting for 9 of 12 (75%) missed congenital heart defects. Of 664 studies with normal cardiac findings on the anatomic ultrasound examinations, no additional instances of CCHD were detected by fetal echocardiography. No unanticipated instances of CCHD were diagnosed postnatally. CONCLUSIONS With current American Heart Association screening guidelines, automatic fetal echocardiography in the setting of normal detailed anatomic ultrasound findings provided limited benefit in detecting congenital heart defects that would warrant immediate postnatal interventions. More selective use of automatic fetal echocardiography in at-risk pregnancies should be explored.
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Affiliation(s)
- Rahul Krishnan
- Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, Virginia, USA
| | - Laura Deal
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Christian Chisholm
- Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, Virginia, USA
| | - Briana Cortez
- Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, Virginia, USA
| | - Annelee Boyle
- Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, Virginia, USA
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3
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Cawyer CR, Kuper SG, Ausbeck E, Sinkey RG, Owen J. The added value of screening fetal echocardiography after normal cardiac views on a detailed ultrasound. Prenat Diagn 2019; 39:1148-1154. [PMID: 31499581 DOI: 10.1002/pd.5557] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 08/19/2019] [Accepted: 08/23/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Evaluate fetal echocardiography's ability to detect critical (lesions requiring immediate neonatal intensive care) congenital heart disease (CHD) after normal anatomic cardiac views on detailed ultrasound. METHODS Singletons with both a detailed ultrasound at 18 + 0 to 22 + 6 weeks and echocardiogram performed at least 14 days later and at 20 + 0 to 24 + 6 weeks. Cases with cardiac pathology on detailed ultrasound were excluded. Different combinations of cardiac views were described: Basic (four-chamber, outflow tracts), Expanded (plus three-vessel view), and Complete (plus ductal/aortic arches). "Normal" was defined on either 2D gray scale or color Doppler. Primary outcome was rates of critical CHD missed on ultrasound but seen on fetal echocardiogram. RESULTS One thousand two hundred twenty-three women had normal Basic cardiac views. One thousand one hundred ninety (97.3%) were confirmed normal on echocardiogram. Twenty-one (1.71%) total CHDs were missed, and three were critical (0.25%; 95% CI, 0.03%-0.53%). Of the 1,223 women, 763 had Complete views. Ten (1.31%) total CHDs were missed and one (0.13%; 95% CI, 0.13%-0.36%) was confirmed critical. CONCLUSION Fetal echocardiography can increase CHD detection despite normal cardiac anatomy on detailed ultrasound; however, CHDs missed are rarely critical. Approximately 750 fetal echocardiograms need to be performed to detect one critical CHD with Complete normal cardiac views on detailed ultrasound.
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Affiliation(s)
- Chase R Cawyer
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Spencer G Kuper
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elizabeth Ausbeck
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rachel G Sinkey
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - John Owen
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
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Letourneau KM, Horne D, Soni RN, McDonald KR, Karlicki FC, Fransoo RR. Advancing Prenatal Detection of Congenital Heart Disease: A Novel Screening Protocol Improves Early Diagnosis of Complex Congenital Heart Disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1073-1079. [PMID: 29027708 DOI: 10.1002/jum.14453] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/17/2017] [Accepted: 07/23/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Prenatal diagnosis of complex congenital heart disease (CHD) during routine obstetric ultrasound (US) examinations improves postnatal outcomes, but sensitivity is low (<40%). Our objective was to improve our prenatal detection of complex CHD with implementation of a specific screening protocol. METHODS From January 2003 to December 2013, 506 consecutive confirmed cases of complex CHD in the province of Manitoba, Canada, were analyzed to compare the sensitivity and positive predictive value of prenatal US detection of complex CHD before and after the introduction of a novel prenatal screening protocol. The intervention was done in October 2004, emphasizing screening and not diagnosis of complex CHD. It involved education, practical scanning tips, a checklist, and feedback on cases. We also assessed the effect of the intervention in different screening settings: community hospitals, tertiary hospitals, and fetal assessment units. RESULTS The sensitivity for detecting complex CHD increased from 29.8% to 88.3% (P < .0001), while the positive predictive value remained high. The largest improvement in detection was found for US units in community hospitals (52.4% higher; P < .0001), followed by tertiary hospitals (39.9%; P = .0004), and fetal assessment units (7.2%; P = .16). Additionally, there was a significant decrease in the presentation of neonates in critical condition from before to after the implementation (24.3% to 13.1%, respectively; P = .0165). CONCLUSIONS Implementing a focused routine prenatal screening protocol can vastly improve detection rates of critical cardiac abnormalities. The improvement in community hospitals was particularly important because early detection ensured that the birth was planned to take place in an appropriate facility. Our novel protocol can be performed by all sonographers, regardless of experience, equipment used, and hospital setting.
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Affiliation(s)
- Karen M Letourneau
- Division of Pediatric Cardiology, Department of Pediatrics and Child Health, University of Manitoba, Health Sciences Center, Pediatric Cardiology, Winnipeg, Manitoba, Canada
| | - David Horne
- Section of Cardiac Surgery, Dalhousie University, IWK Health Center, Children's Heart Center Halifax, Nova Scotia, Canada
| | - Reeni N Soni
- Division of Pediatric Cardiology, Department of Pediatrics and Child Health, University of Manitoba, Health Sciences Center, Pediatric Cardiology, Winnipeg, Manitoba, Canada
| | - Keith R McDonald
- Department of Diagnostic Imaging, Saint Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Fern C Karlicki
- Department of Diagnostic Imaging, Saint Boniface Hospital, Winnipeg, Manitoba, Canada
- Department of Radiology, Ultrasound, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Randy R Fransoo
- University of Manitoba, Manitoba Center for Health Policy, Winnipeg, Manitoba, Canada
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5
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Gurram P, Figueroa R, Sipusic E, Kuhnly N, Clark S, Janicki MB. Isolated Single Umbilical Artery and Fetal Echocardiography: A 25-Year Experience at a Tertiary Care City Hospital. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:463-468. [PMID: 28850695 DOI: 10.1002/jum.14353] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/17/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To review our 25-year experience with a single umbilical artery and fetal echocardiography to estimate the need for this test in cases of an isolated single umbilical artery. METHODS We conducted a retrospective review of 436 patients with a diagnosis of a single umbilical artery at our institution between 1990 and 2015. Two hundred eighty-eight women had both an anatomic survey and a fetal echocardiogram. Pregnancies with concurrent extracardiac anomalies or aneuploidy were excluded. The study population was divided into 3 groups based on cardiac views on the anatomic survey: normal, incomplete, and suspicious. Echocardiographic results were compared among the 3 groups. The primary outcome measure was the incidence of cardiac anomalies in the normal group at fetal echocardiography. The data were analyzed by the χ2 test or Fisher exact test. RESULTS The mean maternal age ± SD of the group was 29.2 ± 6.2 years; 44.1% were primiparas. The mean gestational age at diagnosis was 22.6 ± 5.2 weeks, and the mean gestational age at fetal echocardiography was 25.1 ± 3.6 weeks. In the normal group, 99.1% (230 of 232) of women had a normal fetal echocardiogram; the 2 abnormal cases were ventricular septal defects. Normal echocardiograms were obtained in 81.8% (36 of 44) and 25.0% (3 of 12) of the "incomplete" and "suspicious" groups, respectively. CONCLUSIONS Fetuses with a single umbilical artery, in the absence of structural abnormalities, and with normal cardiac views at the time of the anatomic survey do not warrant an echocardiogram.
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Affiliation(s)
- Padmalatha Gurram
- Department of Obstetrics and Gynecology, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
| | - Reinaldo Figueroa
- Department of Obstetrics and Gynecology, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
| | - Elizabeth Sipusic
- Department of Obstetrics and Gynecology, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
| | - Nicole Kuhnly
- Department of Obstetrics and Gynecology, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
| | - Shealagh Clark
- Department of Obstetrics and Gynecology, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
| | - Mary Beth Janicki
- Department of Obstetrics and Gynecology, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
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6
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Benacerraf BR, Minton KK, Benson CB, Bromley BS, Coley BD, Doubilet PM, Lee W, Maslak SH, Pellerito JS, Perez JJ, Savitsky E, Scarborough NA, Wax J, Abuhamad AZ. Proceedings: Beyond Ultrasound First Forum on Improving the Quality of Ultrasound Imaging in Obstetrics and Gynecology. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:7-18. [PMID: 29297609 DOI: 10.1002/jum.14504] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/26/2017] [Indexed: 06/07/2023]
Abstract
The Beyond Ultrasound First Forum was conceived to increase awareness that the quality of obstetric and gynecologic ultrasound can be improved, and is inconsistent throughout the country, likely due to multiple factors, including the lack of a standardized curriculum and competency assessment in ultrasound teaching. The forum brought together representatives from many professional associations; the imaging community including radiology, obstetrics and gynecology, and emergency medicine among others; in addition to government agencies, insurers, industry, and others with common interest in obstetric and gynecologic ultrasound. This group worked together in focus sessions aimed at developing solutions on how to standardize and improve ultrasound training at the resident level and beyond. A new curriculum and competency assessment program for teaching residents (obstetrics and gynecology, radiology, and any other specialty doing obstetrics and gynecology ultrasound) was presented, and performance measures of ultrasound quality in clinical practice were discussed. The aim of this forum was to increase and unify the quality of ultrasound examinations in obstetrics and gynecology with the ultimate goal of improving patient safety and quality of clinical care. This report describes the proceedings of this conference including possible approaches to resident teaching and means to improve the inconsistent quality of ultrasound examinations performed today.
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Affiliation(s)
| | | | - Carol B Benson
- Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - Bryann S Bromley
- Brigham & Women's Hospital, Harvard Medical School, Boston, MA
- Massachusetts General Hospital, Boston, MA
| | - Brian D Coley
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Wesley Lee
- Texas Children's Hospital Pavilion for Women, Houston, TX
| | | | | | - James J Perez
- OhioHealth Obstetrics and Gynecology Physicians, Columbus, OH
| | - Eric Savitsky
- University of California, Los Angeles, Los Angeles, CA
| | | | - Joseph Wax
- Maine Medical Partners-Women's Health Maternal Fetal Medicine, Portland, ME
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7
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Proceedings: Beyond Ultrasound First Forum on improving the quality of ultrasound imaging in obstetrics and gynecology. Am J Obstet Gynecol 2018; 218:19-28. [PMID: 28688814 DOI: 10.1016/j.ajog.2017.06.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/22/2017] [Accepted: 06/26/2017] [Indexed: 11/23/2022]
Abstract
The Beyond Ultrasound First Forum was conceived to increase awareness that the quality of obstetric and gynecologic ultrasound can be improved, and is inconsistent throughout the country, likely due to multiple factors, including the lack of a standardized curriculum and competency assessment in ultrasound teaching. The forum brought together representatives from many professional associations; the imaging community including radiology, obstetrics and gynecology, and emergency medicine among others; in addition to government agencies, insurers, industry, and others with common interest in obstetric and gynecologic ultrasound. This group worked together in focus sessions aimed at developing solutions on how to standardize and improve ultrasound training at the resident level and beyond. A new curriculum and competency assessment program for teaching residents (obstetrics and gynecology, radiology, and any other specialty doing obstetrics and gynecology ultrasound) was presented, and performance measures of ultrasound quality in clinical practice were discussed. The aim of this forum was to increase and unify the quality of ultrasound examinations in obstetrics and gynecology with the ultimate goal of improving patient safety and quality of clinical care. This report describes the proceedings of this conference including possible approaches to resident teaching and means to improve the inconsistent quality of ultrasound examinations performed today.
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9
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Sklansky MS, DeVore GR. Reply. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1832-1833. [PMID: 27462132 DOI: 10.7863/ultra.16.05011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Mark S Sklansky
- Department of Pediatrics, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California USA
| | - Greggory R DeVore
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California USA
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10
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Kumar P. Universal Pulse Oximetry Screening for Early Detection of Critical Congenital Heart Disease. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2016; 10:35-41. [PMID: 27279759 PMCID: PMC4892233 DOI: 10.4137/cmped.s33086] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/07/2016] [Accepted: 04/07/2016] [Indexed: 11/29/2022]
Abstract
Critical congenital heart disease (CCHD) is a major cause of infant death and morbidity worldwide. An early diagnosis and timely intervention can significantly reduce the likelihood of an adverse outcome. However, studies from the United States and other developed countries have shown that as many as 30%–50% of infants with CCHD are discharged after birth without being identified. This diagnostic gap is likely to be even higher in low-resource countries. Several large randomized trials have shown that the use of universal pulse-oximetry screening (POS) at the time of discharge from birth hospital can help in early diagnosis of these infants. The objective of this review is to share data to show that the use of POS for early detection of CCHD meets the criteria necessary for inclusion to the universal newborn screening panel and could be adopted worldwide.
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Affiliation(s)
- Praveen Kumar
- Associate Chair, Visiting Professor of Pediatrics, Department of Pediatrics, University of Illinois, Children's Hospital of Illinois, Peoria, IL, USA
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11
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Bahtiyar MO, Copel JA. Screening for congenital heart disease during anatomical survey ultrasonography. Obstet Gynecol Clin North Am 2015; 42:209-23. [PMID: 26002162 DOI: 10.1016/j.ogc.2015.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Congenital heart disease (CHD) is among the most common congenital abnormalities. The prevalence of CHD ranges between 0.6% and 1.2% of live births. Despite its high prevalence, CHD is also among the most commonly missed abnormalities during prenatal ultrasound examination. A simple yet systematic approach to fetal heart examination, regular feedback, and implementation of training programs could improve detection rates and, in turn, neonatal outcome.
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Affiliation(s)
- Mert Ozan Bahtiyar
- Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Science, Yale Fetal Cardiovascular Center, Yale Fetal Care Center, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA.
| | - Joshua A Copel
- Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Science, Yale Fetal Cardiovascular Center, Yale Fetal Care Center, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA; Department of Pediatrics, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
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12
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Pruetz JD, Carroll C, Trento LU, Chang RK, Detterich J, Miller DA, Sklansky M. Outcomes of critical congenital heart disease requiring emergent neonatal cardiac intervention. Prenat Diagn 2014; 34:1127-32. [DOI: 10.1002/pd.4438] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 05/01/2014] [Accepted: 06/16/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Jay D. Pruetz
- Division of Pediatric Cardiology; Children's Hospital Los Angeles; Los Angeles CA USA
- Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Caitlin Carroll
- Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Luca U. Trento
- Division of Pediatric Cardiology; Kaiser Permanente; Roseville CA USA
| | - Ruey-Kang Chang
- Division of Pediatric Cardiology; Harbor-UCLA Medical Center; Torrance CA USA
| | - Jon Detterich
- Division of Pediatric Cardiology; Children's Hospital Los Angeles; Los Angeles CA USA
- Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - David A. Miller
- Keck School of Medicine; University of Southern California; Los Angeles CA USA
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Mark Sklansky
- Division of Pediatric Cardiology; David Geffen School of Medicine at UCLA; Los Angeles CA USA
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13
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Jegatheeswaran A, Oliveira C, Batsos C, Moon-Grady AJ, Silverman NH, Hornberger LK, Coyte P, Friedberg MK. Costs of prenatal detection of congenital heart disease. Am J Cardiol 2011; 108:1808-14. [PMID: 21907953 DOI: 10.1016/j.amjcard.2011.07.052] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 07/16/2011] [Accepted: 07/16/2011] [Indexed: 10/17/2022]
Abstract
Little information is available about the transportation costs incurred from the missed prenatal diagnosis of congenital heart disease (CHD). The objectives of the present study were to analyze the costs of emergency transportation related to the postnatal diagnosis of major CHD and to perform a cost/benefit analysis of additional training for ultrasound technicians to study the implications of improved prenatal detection rates. The 1-year costs incurred for emergency transportation of pre- and postnatally diagnosed infants with CHD in Northern California and North Western Nevada were calculated and compared. The prenatal detection rate in our cohort (n = 147) was 30.6%. Infants postnatally diagnosed were 16.5 times more likely (p <0.001) to require emergency transport. The associated emergency transportation costs were US$542,143 in total for all patients with CHD. The mean cost per patient was $389.00 versus $5,143.51 for prenatally and postnatally diagnosed infants, respectively (p <0.001). Assuming an improvement in detection rates after 1-day training for ultrasound technicians, the investment in training cost can be recouped in 1 year if the detection rate increased by 2.4% to 33%. Savings of $6,543,476 would occur within 5 years if the detection rate increased to 50%. In conclusion, CHD diagnosed postnatally results in greater costs related to emergency transportation of ill infants. Improving the prenatal detection rates through improved ultrasound technician training could result in considerable cost savings.
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Sklansky MS, Berman DP, Pruetz JD, Chang RKR. Prenatal screening for major congenital heart disease: superiority of outflow tracts over the 4-chamber view. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:889-899. [PMID: 19546331 DOI: 10.7863/jum.2009.28.7.889] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the relative importance of the 4-chamber view (4CV) compared with the outflow tract views (OFTVs) in prenatal screening for major congenital heart disease (CHD). METHODS We prospectively evaluated 200 consecutive infants undergoing cardiac surgery at our institution for major CHD. By reviewing the infants' medical records and conducting bedside interviews with their parents or guardians, we evaluated detection rates both prenatally and postnatally (before and after discharge to home), and we noted any prenatally identifiable risk factors for CHD. For each infant, we determined whether the 4CV or OFTVs would be expected to have been normal or abnormal on routine midgestation screening fetal sonography. RESULTS A prenatal diagnosis of CHD was made in 65 infants (33%): 30 of 124 low-risk pregnancies (24%) and 35 of 76 high-risk pregnancies (46%). An abnormal screening midgestation 4CV would have been expected in up to 63% of the infants, whereas abnormal midgestation OFTVs would have been expected in up to 91% of the infants. Thus, the potential sensitivity for detecting major CHD was higher with the OFTVs than with the 4CV (91% versus 63%; P < .001). Moreover, the OFTVs were more sensitive than the 4CV for detecting ductal-dependent forms of CHD. Diagnosis after discharge to home occurred in 39 of 135 postnatal diagnoses (29%), including many cases of isolated outflow tract abnormalities requiring early invasive intervention. CONCLUSIONS Cases of major neonatal CHD with OFTV abnormalities predominate over cases with 4CV abnormalities, particularly among those forms of CHD requiring early invasive intervention.
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Affiliation(s)
- Mark S Sklansky
- Division of Pediatric Cardiology, Childrens Hospital Los Angeles, Los Angeles, California 90027, USA.
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15
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Cohen L, Mangers K, Platt L, Julien S, Gotteiner N, Dungan J, Grobman W. Quality of 2- and 3-dimensional fast acquisition fetal cardiac imaging at 18 to 22 weeks: ramifications for screening. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:595-601. [PMID: 19389898 DOI: 10.7863/jum.2009.28.5.595] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the frequency with which 6 different fetal cardiac views taken during a fetal ultrasound examination at 18 to 22 weeks' gestation can be obtained satisfactorily for cardiac anomaly screening using either a 2-dimensional (2D) static or 3-dimensional (3D) fast acquisition technique. METHODS A prospective study of 100 low-risk women undergoing an anatomic survey was performed. Standard static 2D and 3D fast acquisition volumes were obtained on all patients. The 2D and 3D images were assigned, in a random order, to be independently graded by 3 reviewers. The degree of inter-reviewer agreement was assessed through the use of the Cohen kappa statistic. The factors contributing to satisfactory imaging were evaluated by random effects logistic regression. RESULTS A significant proportion of both 2D and 3D images were judged unsatisfactory for screening purposes. However, 2D images were significantly more likely, for all cardiac views, to be judged satisfactory (P < .05). The odds ratios for the 2D technique's being more likely than the 3D technique to provide images satisfactory for screening were 2.6 for the 4-chamber view, 2.4 for the right ventricular outflow tract, 4 for the left ventricular outflow tract, 3.2 for the 3-vessel view, 8.6 for the aortic arch, and 2.2 for the ductal arch. CONCLUSIONS In this prospective study, static 2D imaging was significantly more likely than fast acquisition 2D imaging to yield cardiac views of high enough quality to satisfactorily screen for anomalies.
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Affiliation(s)
- Leeber Cohen
- Department of Obstetrics and Gynecology, Divisions of Obstetric and Gynecologic Ultrasound, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Jelliffe-Pawlowski LL, Walton-Haynes L, Currier RJ. Using second trimester ultrasound and maternal serum biomarker data to help detect congenital heart defects in pregnancies with positive triple-marker screening results. Am J Med Genet A 2008; 146A:2455-67. [DOI: 10.1002/ajmg.a.32513] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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