Cyanotic Congenital Heart Disease Modes of Presentation and Prenatal Detection.

Abstract

Prenatal detection of structural congenital heart disease (CHD) optimises cardiovascular stability pre-operatively and post-operative outcomes. We compared prenatal detection rates of critical CHD in units offering universal fetal anomaly scans with those offering imaging to selected women. One hundred and thirteen infants met inclusion criteria. The overall pre-natal detection rate for critical CHD was 57% of liveborn infants. It was 71% (57/80) in hospitals who offered a universal anomaly scan and 29% (9/31) in centres offering a limited service. Postnatal diagnosis was associated with PICU admission (p=0.016) and preoperative mechanical ventilation (p=0.001). One-year mortality was 10 fold higher in the postnatally diagnosed group 15% vs 1.55% (p=0.0066). There is a significant disparity between centres offering universal anomaly versus selective screening. Prenatal detection confers advantage in terms of pre-operative stability and one year survival. Failure to deliver an equitable service exposes infants with CHD to avoidable risk. Abreviations CHD, congenital heart disease; PICU, paediatric intensive care unit; NWIHP, National Women and Infants Health Programme; NCHC, CHIC, National Children’s Heart Centre at Children’s Health Ireland at Crumlin; TAPVD, total anomalous pulmonary venous drainage, HLHD, Hypoplastic left heart disease, HRHD, Hypoplastic right heart disease, LVOTO, left ventricular outflow tract obstruction.