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Changed outcomes of fetuses with congenital heart disease: new Italian Multicentre study
Vlasta Fesslova'1, Jelena Brankovic, Chiara Boschetto
1aCenter of Fetal Cardiology, Policlinico San Donato IRCSS, Milan bDepartment of Obstetrics and Gynecology, Ospedale Civile di Legnano, Legnano cDepartment of Pediatric Cardiology and Obstetrics and Gynecology, Policlinico S. Orsola IRCCS, Bologna dDepartment of Pediatric Cardiology and Obstetrics and Gynecology, Sapienza University of Rome, Rome eDepartment of Cardiology, Azienda Ospedaliera Bolzano, Bolzano fDepartment of Pediatric Cardiology, Ospedale Ferrarotto, Azienda Vittorio Emanuele, Catania gDepartment of Pediatrics, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Insights
Outcomes for fetuses with congenital heart disease (CHD) have improved, showing reduced overall and surgical mortality in a recent era compared to a previous study. This reflects advancements in perinatal management and treatment for affected fetuses.
Area of Science:
- Perinatal Medicine
- Fetal Cardiology
- Congenital Disorders
Background:
- Congenital heart disease (CHD) presents significant challenges in fetal diagnosis and management.
- Previous studies established baseline outcomes for fetuses with CHD between 1983-1996.
Purpose of the Study:
- To analyze and compare the outcomes of fetuses diagnosed with congenital heart disease (CHD) between 2000-2005.
- To evaluate changes in mortality and survival rates against a historical multicentre study (1983-1996).
Main Methods:
- Prospective data collection from seven centers for 649 fetuses with confirmed diagnosis and 6-month follow-up.
- Analysis included gestational age at diagnosis, associated anomalies, and pregnancy management decisions.
Main Results:
- Overall survival improved significantly to 73.9% (376/509) compared to 45% in the previous study (P<0.0001).
- Total surgical/postprocedure mortality decreased to 20.6% (59/287) from 37% previously (P<0.003).
- Early diagnosis (<24 weeks) was associated with a significantly lower rate of pregnancy termination (P<0.001).
Conclusions:
- Improved perinatal management and treatment have led to reduced overall and surgical mortality for fetuses with CHD.
- Current data indicate a positive trend in outcomes for fetuses diagnosed with congenital heart disease in the recent era.
Objectives:
To analyse the outcomes of fetuses with congenital heart disease between 2000 and 2005 in comparison to a previous multicentre study regarding the period 1983-1996.
Participants And Methods:
Data of seven centres were prospectively collected, the inclusion criteria being a confirmed fetal diagnosis after birth or at autopsy and a known follow-up, for at least 6 months after birth. Data of 649 fetuses, median age at diagnosis 24 weeks' gestation (15-37), 340/649 (52.4%) diagnosed before 24 weeks, were analysed.
Results:
Sixty seven and 59 cases had chromosomal or extracardiac anomalies (10.3 and 9.1%). Termination of pregnancy was chosen in 21.6% of cases versus 28.9% in the previous study, being significantly lower in cases with early diagnosis (P <0.001). Out of 509 fetuses continuing pregnancy, 23 died in utero (4.5%) and 110 (21.1%) postnatally, versus 43% in the previous study (P <0.0017). Total surgical/postprocedure death occurred in 20.6% (59/287 infants) versus 37% previously (P <0.003), 67 infants being premature and 35 with associated chromosomal or extracardiac anomalies. The current overall mortality rate was higher in cases with chromosomal or extracardiac anomalies (59.5 and 51.35%, respectively, whereas it was 20.1% in isolated congenital heart disease). Overall current survival was 376 of 509 (73.9%) versus 45% in the previous study (P <0.0001).
Conclusion:
Our data show a reduced overall and surgical mortality, with respect to our previous study, resulting from resulting from an improved perinatal management and treatment of affected fetuses in the more recent era.
