Iwona Strzelecka, Jadwiga Moll, Katarzyna Kornacka, Andrzej Zieliński and Maria Respondek-Liberska
A retrospective analysis of medical records of selected 83 cases (pregnant women and fetuses of patients from the database of the Department of Diagnosis and Prevention of Congenital Malformations ICZMP in Lodz in the years 2007-2012) who had minimum 2 echocardiographic exams. In this group 220 echocardiography exams were performed: in 62 fetuses 2x and in 21 fetuses 3x or more. After exclusion of intrauterine demises and terminated pregnancies, 72 cases have been qualified for further analysis. Heart defects in this material were initially divided into four groups: the most serious defects, critical, serious and evolving. Group of the most serious defects was excluded from the 2nd stage of analysis. An attempt to subtract the group of “evolving” heart defects from the group of severe and critical defects was conducted. This group of defects was initially classified as “severe evolving to the critical”, as hemodynamics progression was observed during intrauterine life. Mortality in the subgroup of evolving defects was 71.4 %, in the group of critical defects 36.8 % and in the group of heavy defects 34.4 % ( chi-square test 0.05). In the group of evolving defects the mortality rate after cardiac surgery was :7/11 infants (63 %) and in the group of severe defects 7/26 (26.9 % ) (Fisher test 0.018). There were no other differentiating features found within the statistical analysis of the study groups.
Conclusions: Prenatal classification of fetal heart defects based on echocardiographic monitoring allows to observe the progression of hemodynamic changes in selected fetuses. This group of defects was encumbered with the greatest mortality in the neonatal and postoperative period.
Monika Wojtyra, Jadwiga Moll and Maria Respondek-Liberska
Hypoplastic Left Heart Syndrome (HLHS) is the most common heart defect in the population of fetuses and majority of Polish women deceided to continue their pregnancies despite prenatal diagnosis.
The aim of the study:
Are there any differences in newborns with HLHS after prenatal diagnoses and with postnatal diagnoses, operated on in ICZMP (Polish Mother’s Memorial Hospital) in Lodz in the years 2005-2010.
Material and Methods:
A retrospective analysis of medical records of 155 newborns from the subdivision of Anaesthesiology and Paediatric Intensive Care (ICZMP) in two groups: prenatally diagnosed (n = 87) and without prenatal diagnosis (n = 68).
Newborns were born with normal birth weights, in two groups prenatal and postnatal (3109.5 ± 494.8g vs. 3258.6 ± 443.1 g, p = 0.06 ). Most of them (85%) were born on time and in good condition (9-10 points on the Apgar). The surgery was performed earlier in prenatal group (p = 0.0364). The chance of surgery between 6th and 10th day after birth in prenatal group was twice as high as in the group diagnosed after birth (OR = 2.0 [0.9 - 4.3]). The infant’s average length of stay in the ICU after the first stage of treatment was 8 days and was almost the same in both groups (8,0 [5,0 - 20,5] vs. 8,0 - 16,0]; NS). Total mortality was 19.4% and it did not differ in both groups (p = 0.4596). The risk of death in prematurity group was 5x higher than in group of newborns delivered at term (p=0,0073). In prenatal group cardiac surgery was earlier than in group diagnosed after delivery (p=0,0364). Neonates with late surgery had longer hospitalization, compared with early surgery (44 days vs 33 days, p=0,0073). Longer hospital stay means higher hospital cost (for cardiac surgery department circa 3000 zł per 1 patient with HLHS, meaning 90 000 zl per year for 30 patients).
1) The neonatal outcome of newborns with HLHS in ICU, in our center in years 2005-2010, in two groups: after prenatal diagnoses and in postnatal diagnoses, were similar.
2) The main differences were a) an increased risk of death in case of premature delivery (p=0,0073) b) earlier I stage Norwood in prenatal group (p=0,0364) meaning lower costs for single institution, meaning lower costs for the National Health System.
Maria Respondek-Liberska, Katarzyna Janiak, Maciej Słodki, Hanna Moczulska and Jadwiga Moll
In the Polish National Registry for Fetal Cardiac Pathology d-TGA ranked in 5th place on the list of most common heart defects after HLHS, AVSD, VSD and TOF and accounted for 3,5% of all registered cardiac malformations. The following increase in the detection of d-TGA in Poland was observed: 8 fetuses in 2006, 20 fetuses in 2008, 30 fetuses in 2012 (p<0,05, McNemara test).
The aim of this study was to analyze selected fetal and neonatal data in a group of 55 patients with d-TGA in the years 1997-2012 in the single reference prenatal cardiology center, type C (> 120 prenatal CHD per year). Mean gestational age was 28,2+/-4,7 weeks, which decreased from 36st week (in 2007) to 30th week (in 2012) (p=0,006; ANOVA & post hoc NIR test).
Demise in utero, termination of pregnancy, demise before cardiac surgery (4%) and postoperative deaths (2%) were taken into account (p >0,05 test χ2). Rashkind procedure during 48h after delivery was performed in 36% of neonates.
Conclusion: In the past 12 years we have observed a tendency to better detection of prenatal d-TGA (p <0,05) and to identify d-TGA at earlier gestational age (p=0,006). “Hidden mortality” (before surgery) was higher than postoperative mortality in the neonatal period, however statistically the difference was not significant (p>0,05).
Aneta Krasoń, Joanna Płużańska, Maciej Łukaszewski, Jadwiga Moll and Maria Respondek-Liberska
Prenatal diagnosis of total anomolous pulmonary venous connection (intracardiac) was diagnosed in fetus with dextrocardia and complex heart defect, which allowed fetal echocardiography monitoring, planning the time and place for delivery as well as early cardiac surgery. The differences between prenatal and postnatal evaluations were underlined. Despite life treathening condition neonate was asymptomatic without any heart murmur for the first 3 days after delivery.
Maria Respondek-Liberska, Łukasz Sokołowski, Maciej Słodki, Katarzyna Zych-Krekora, Iwona Strzelecka, Michał Krekora, Iwona Maroszyńska, Jadwiga Moll and Jacek Moll
Total anomalous pulmonary venous connection (TAPVC) is a congenital heart defect (CHD), in which all pulmonary veins connect to the systemic veins or to the right atrium/coronary sinus instead of the left atrium. We present a case report of fetus with prenatally diagnosed isolated infracardiac type of TAPVC in 38th week of gestation. In fetal echocardiographic examination performed in the Department of Prenatal Cardiology, the fetus presented lack of visible pulmonary veins connection to left atrium, abnormal venous confluence behind left atrium, additional vein leading from abdominal cavity to mediastinum and abnormal smooth Doppler blood flow in pulmonary confluence. The accurate prenatal diagnosis allowed to deliver the neonate at term, in tertiary center one day after diagnosis, and to perform surgical reposition of pulmonary veins the following day. The neonate was referred home in a good condition after 28 days of hospitalization. This case is a good example of the value of the 3rd trimester echocardiography.
Maria Respondek-Liberska, Joanna Płużańska, Katarzyna Zych-Krekora, Ewa Czichos, Maciej Słodki and Jadwiga Moll
From 2012-2014 we selected fetuses who had an isolated congenital heart defect and restriction of the foramen ovale defined as its diameter of 4 mm or less, shunt across foramen ovale, V max > 70 cm/sec along with a typical harsh sound during fetal ausculation during echocardiography and reversal flow in pulmonary veins, no extracardiac anomalies, singleton pregnancies and delivery > 37 weeks of gestation. It was retrospective analysis of 16 cases: There were 10 non-survivors and 6 survivors The only significant difference between survivors and non-survivors pertained to the fraction of newborns operated on up to 11th day, which was significantly higher among the survivors (5/6 vs. 2/8, p=0.031).
1) In the event of prenatal restriction of the foramen ovale early surgery by day 10 had a statistically better outcome in terms of survival compared to cases that underwent surgery at a later period at our Institute.
2) Prenatal restriction of the foramen ovale was more often related to male gender and in 75% of cases in our series had complicated follow-up: neonatal death or prolonged hospital stay.3) Information from prenatal echocardiography regarding restriction of the foramen ovale should be taken into consideration as valuable information suggesting priority for early cardiac surgery.
Joanna Płużańska, Paweł Dryżek, Hanna Moczulska, Maciej Słodki, Michał Krekora, Ewa Gulczyńska, Tomasz Moszura, Jadwiga Moll and Maria Respondek-Liberska
Pulmonary valve stenosis is a congenital heart defect that is possible to detect and diagnose during prenatal life. We present a retrospective analysis of ten cases with isolated critical pulmonary valve stenosis (IPVS) to establish echocardiographic criteria which could predict the possibility for postnatal balloon valvuloplasty performed shortly after delivery.