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Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Geographic Distribution of Congenital Heart Disease: A Single Surgical Center Experience
Jennifer Klein1, Gina Dwyer2, Mary T Donofrio1
1Division of Cardiology, Children's National Hospital, Washington, DC.
Insights
Spatial analysis revealed geographic clustering for hypoplastic left heart syndrome (HLHS) and d-transposition of the great arteries (TGA) cases. These findings suggest non-random distribution and opportunities for enhanced fetal cardiac care delivery.
Area of Science:
- Pediatric Cardiology
- Spatial Epidemiology
- Congenital Heart Disease
Background:
- Hypoplastic left heart syndrome (HLHS) and d-transposition of the great arteries (TGA) are critical congenital heart defects.
- Understanding the spatial distribution of these conditions can inform public health strategies and resource allocation.
Purpose of the Study:
- To investigate the spatial clustering or dispersion patterns of prenatally and postnatally detected HLHS and TGA cases.
- To determine if the geographic occurrence of these congenital heart defects is random.
Main Methods:
- Retrospective study of 105 patients with HLHS or TGA diagnosed between 2012 and 2016.
- Utilized geographic information systems (GIS) software and the nearest neighbor ratio (NNR) tool for spatial analysis.
Main Results:
- Geographic clustering was observed in pooled prenatally diagnosed HLHS/TGA cases and all total cases (NNR=0.73, 0.66).
- Postnatally detected cases showed no clustering (NNR=1.08), with significant dispersion noted for TGA (NNR=1.22).
- No distinct spatial pattern was found for individually analyzed prenatally detected TGA or HLHS cases.
Conclusions:
- The spatial distribution of HLHS and TGA is non-random, exhibiting geographic clustering.
- Dispersion of postnatally detected TGA cases and overall clustering highlight potential areas for improving fetal cardiac care services.
Objective:
To determine presence of spatial clustering or dispersion of pre and postnatally detected hypoplastic left heart syndrome (HLHS) and d-transposition of the great arteries (TGA) cases.
Study Design:
This retrospective study examined all patients with a prenatal or postnatal diagnosis of HLHS or TGA who had an initial visit or hospitalization at our tertiary care center over a 5-year period from 2012 to 2016 (n = 105). Using geographic information systems software, the nearest neighbor ratio (NNR) tool was used to determine whether statistically significant clustering or dispersion occurred.
Results:
Geographic clustering was observed among prenatally diagnosed pooled cases of HLHS and TGA and all total cases (NNR = 0.73 and 0.66, respectively), but not postnatally detected cases (NNR = 1.08). Notably, there was significant dispersion of postnatally detected TGA cases (NNR = 1.22) There was no pattern for prenatally detected TGA or HLHS when analyzed individually.
Conclusions:
The spatial distribution of HLHS and TGA is not random; these conditions occur in geographic clusters. Clustering of all patients in the study population and dispersion of postnatal diagnosis of TGA represent opportunities for improved delivery of fetal cardiac care.
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