Assessing the value of postnatal echocardiograms prior to congenital duodenal obstruction repair

Congenital duodenal obstruction (CDO) is surgically repaired in the immediate postnatal period; however, its association with congenital heart disease warrants preoperative evaluation of cardiac physiology. Given the availability and accuracy of prenatal echocardiography, we sought to determine the value of an additional postnatal preoperative echocardiogram.

A retrospective cohort study was conducted via chart review on patients diagnosed with CDO at a tertiary children's hospital from January 2013 to December 2023. Echocardiogram findings were reviewed, and defects were divided based on primary physiology.

Of the 90 patients with CDO, 31 (34%) patients had an associated cardiac anomaly-20 (65%) shunting lesions, 7 (23%) conotruncal anomalies, and 1 (2%) each had: single ventricle physiology, partial anomalous pulmonary venous return (PAPVR), and a vascular ring. Forty (44%) patients had an associated syndrome or chromosomal abnormality. Prenatal echocardiogram had a positive predictive value of 100% [80-100%], negative predictive value of 78% [58-100%], sensitivity of 75% [53-89%], and specificity of 100% [82-100%] for finding the described anomalies (p < 0.0001). Of the 38 patients who had both prenatal and postnatal echocardiograms, 5 (13%) had a ventricular septal defect identified postnatally that was not seen prenatally. There were no false positive findings prenatally.

In the presence of a prenatal echocardiogram, a postnatal echocardiogram is unlikely to identify a clinically significant additional cardiac anomaly that may impact CDO repair. Our data suggests that surgical repair of CDO need not be delayed for a postnatal echocardiogram if a prenatal echocardiogram was performed.