A patient with a borderline small left heart requires difficult clinical decision making during prenatal and neonatal periods. This report describes the unusual natural history of a newborn with prenatally diagnosed hypoplastic left heart structures and early spontaneous postnatal closure of the interatrial communication. Initial deterioration from pulmonary edema and low-cardiac output improved with postnatal intensive care. During the seventh week of life, aortic coarctation was diagnosed and the infant underwent uneventful surgical repair. Despite transient clinical deterioration, early spontaneous closure of the interatrial communication in a newborn with borderline small left heart could be associated with gradual hemodynamic adaptation to postnatal biventricular circulation.
To assess the accuracy of prenatal ultrasonography (US) for congenital heart defects (CHD) in the entire pregnant population undergoing US examination over a 10-year period. Study design: From 1/1990 to 12/2002, 30746 pregnant women underwent prenatal US examination inclusive of four-chambers view in all cases and ventricular outflow tracts in about 50% of cases. The operators were obstetricians with a different degree of experience in US (2 months-20 years). The prenatal detection rate (DR) of US in the detection of CHD was related to the type of anomaly and indications for the US exam (screening vs other indications/referral). All patients were followed until delivery or pregnancy termination. Clinical or autopsy confirmation of abnormal antenatal finding was obtained in all cases. Neonatal echocardiogram was performed in all babies admitted to NICU, in those with heart murmurs detected within 24 hours of birth, and in those with dysmorphic features. Obstetricians and neonatologists met weekly to discuss cases of cardiac anomaly diagnosed pre-or post-natally. Statistical analysis included Chi-square. Results: 313 cases of CHD occurred (1%), of which 228 (73%) were detected prenatally. The DR for the different subgroups of cardiac malformation were: 1) isolated septal defects: 44% (48/108); 2) atrio-ventricular canals: 95% (52/55); 3) isolated conotruncal defects: 88% (49/56); 4) malformations affecting the size of ventricles: 97% (55/57); 5) other malformations: 62% (23/37). The DR was 40% in screening scans (low-risk pregnancies) and 82% among referrals (p < 0001). Conclusion: In this largest cohort of prenatal screening for CHD, the DR was 73%. Septal defects contributed heavily to the false-positive results. The indication for the US scan significantly influences the sensitivity of the test. P01.02 Evaluation of congenital cardiac findings in the group of high-risk pregnancies
The aim of this study was to present our 4 cases of trisomy 18, with a congenital heart defect detected during the last 6 months. Results Two complex congenital heart defects (CHD) with a very similar anatomy were found during a prenatal ultrasonographic examination – Double outlet right ventricle (DORV) with complete atrioventricular septal defect (AVSDC) – in the 20th and 38th week of gestation and in other two cases – in the 19th and 21st week of gestation – an isolated muscular ventricular septal defect (VSD) was proved. In All fetuses also noncardiac (central nervous, gastro‐intestinal and uropoetical) congenital malformations were present. Conclusion Trisomy 18 (Edwards sy) occurs approximately in 1:7000 live births. 95–100% of these newborns have some form of CHD. Because of a very poor prognosis a surgical correction is usually not considered. Left to their natural course, death occurs at the age of one hour to 18 months, the median life expectance is 5–48 days, according to the presence of severe CHD and associated anomalies.
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