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[Complex Congenital Heart Disease: The Influence of Prenatal Diagnosis]
Marta Correia1, Fabiana Fortunato2, Duarte Martins3
1Serviço de Pediatria. Hospital Vila Franca de Xira. Vila Franca de Xira. Portugal.
Insights
Prenatal diagnosis of complex congenital heart disease (CCHD) did not significantly impact early mortality, though it facilitated appropriate referrals. Most CCHD cases were not diagnosed prenatally, highlighting a need for improved prenatal screening strategies.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Prenatal Diagnosis
Background:
- Complex congenital heart disease (CCHD) comprises severe conditions with significant morbidity and mortality implications.
- Prenatal diagnosis is crucial for managing severe CCHD cases.
- Evaluating the impact of prenatal diagnosis and geographic factors on CCHD outcomes is essential.
Purpose of the Study:
- To assess the influence of prenatal diagnosis on immediate morbidity and early mortality in CCHD.
- To investigate the role of residence and birth place distance to a reference center in CCHD outcomes.
Main Methods:
- Retrospective study of 126 CCHD patients born between 2007 and 2012.
- Analysis of pregnancy follow-up, prenatal diagnosis rates, and birth location relative to a tertiary center.
- Evaluation of immediate morbidity and early mortality, including survival rates at 30 days, 12, and 24 months.
Main Results:
- Prenatal diagnosis was established in 42% of pregnancies, with a significant association between birth location and diagnosis.
- Transposition of great arteries was the most common CCHD (45.2%).
- Actuarial survival rates at 30 days, 12, and 24 months were 85%, 80%, and 75%, respectively. Prenatal diagnosis did not significantly correlate with mortality.
Conclusions:
- The majority of CCHD cases lacked prenatal diagnosis, with all diagnosed cases originating from tertiary centers.
- Prenatal diagnosis did not significantly affect neonatal mortality for CCHD.
- Findings underscore the importance of considering current data when planning congenital heart disease prenatal diagnostic services.
Introduction:
Complex congenital heart disease is a group of severe conditions. Prenatal diagnosis has implications on morbidity and mortality for most severe conditions. The purpose of this work was to evaluate the influence of prenatal diagnosis and distance of residence and birth place to a reference center, on immediate morbidity and early mortality of complex congenital heart disease.
Material And Methods:
Retrospective study of complex congenital heart disease patients of our Hospital, born between 2007 and 2012.
Results:
There were 126 patients born with complex congenital heart disease. In 95%, pregnancy was followed since the first trimester, with prenatal diagnosis in 42%. There was a statistically significant relation between birth place and prenatal diagnosis. Transposition of great arteries was the most frequent complex congenital heart disease (45.2%), followed by pulmonary atresia with ventricular septal defect (17.5%) and hypoplastic left ventricle (9.5%). Eighty-two patients (65.1%) had prostaglandin infusion and 38 (30.2%)were ventilated before an intervention. Surgery took place in the neonatal period in 73%. Actuarial survival rate at 30 days, 12 and 24 months was 85%, 80% and 75%, respectively. There was no statistically significant relation between prenatal diagnosis and mortality.
Discussion:
Most patients with complex congenital heart disease did not have prenatal diagnosis. All cases with prenatal diagnosis were born in a tertiary center. Prenatal diagnosis did not influence significantly neonatal mortality, as already described in other studies with heterogeneous complex heart disease.
Conclusion:
prenatal diagnosis of complex congenital heart disease allowed an adequate referral. Most patients with complex congenital heart disease werenâÄôt diagnosed prenatally. This data should be considered when planning prenatal diagnosis of congenital heart disease.
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