Discordances Between Pre-Natal and Post-Natal Diagnoses of Congenital Heart Diseases and Impact on Care Strategies

Bensemlali, Myriam; Stirnemann, J.; Bidois, J. Le; Lévy, Marilyne; Raimondi, Francesca; Hery, Eric; Stos, Bertrand; Bessières, Bettina; Boudjemline, Younès; Bonnet, Damien

doi:10.1016/j.jacc.2016.05.087

Cited by 51 publications

(42 citation statements)

References 45 publications

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“…Fetal echocardiographic diagnoses in the hands of specialized fetal cardiologists practicing at tertiary care centers results in between 8.1% to 10.6% major discrepancies and 18.7% minor discrepancies when compared to the postnatal diagnosis. , [13][14][15][16][17] The SCH-RC demonstrated a higher rate of major discrepancies and similar minor discrepancies compared with the published data, 31% and 7%, respectively. Our regional pediatric cardiologists have significant time constraints for prenatal cardiology visits and both the physicians and cardiac sonographers have limited or no formal training in fetal cardiology.…”

Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 72%

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The role of regional prenatal cardiac screening for congenital heart disease: A single center experience

Pasierb

Peñalver

Vernon

et al. 2018

Congenital Heart Disease

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 72%

The role of regional prenatal cardiac screening for congenital heart disease: A single center experience

Pasierb

Peñalver

Vernon

et al. 2018

Congenital Heart Disease

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“…Fetal ultrasound screening allows for early detection of CHD [ 12 – 14 ], especially when conducted routinely in tertiary care centers [ 15 – 17 ]. In our hospital, fetal ultrasound screening is routinely conducted for all pregnant women.…”

Section: Discussionmentioning

confidence: 99%

Can echocardiographic screening in the early days of life detect critical congenital heart disease among apparently healthy newborns?

et al. 2018

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BackgroundDelayed diagnosis of critical congenital heart disease (CCHD) carries a serious risk of mortality, morbidity, and handicap. As echocardiography is commonly used to diagnose congenital heart disease (CHD), echocardiographic investigations in newborns may be helpful in detecting CCHD earlier and with higher sensitivity than when using other screening methods. The present study aimed to evaluate the effectiveness of echocardiographic screening for CCHD in a tertiary care center.MethodsA retrospective chart review was conducted among newborns delivered at Hamamatsu University Hospital between June 2009 and May 2016. The study included consecutive newborns who underwent early echocardiographic screening (within the first 5 days of life) performed by pediatric cardiologists, were born at ≥36 weeks of gestation, had a birthweight ≥2300 g, and were cared for in the well-baby nursery. Newborns admitted to the neonatal intensive care unit, as well as those with prenatal diagnosis of CHD and/or clinical symptoms or signs of CHD were excluded. Four CHD outcome categories were defined: critical, serious, clinically significant, and clinically non-significant.ResultsA total of 4082 live newborns were delivered during the study period. Of 3434 newborns who met the inclusion criteria and had complete echocardiography data, 104 (3.0%) were diagnosed as having CHD. Among these, none was initially diagnosed as having critical or serious CHD. Of the 95 newborns who continued follow-up with a cardiologist, 61 (64%) were determined to have non-significant CHDs that resolved within 6 months of life. Review of excluded newborns revealed nine cases of critical or serious CHD; among these newborns, six were diagnosed prenatally and three had some clinical signs of CHD prior to hospital discharge.ConclusionsIn our tertiary care center, echocardiography screening within the first 5 days of life did not help improve CCHD detection rate in newborns without prenatal diagnosis or clinical signs of CHD. Echocardiographic screening may be associated with increased rate of false-positives (defects resulting in clinically non-significant CHDs) in newborns without prenatal diagnosis or suspicion of CHD.

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“… 5 Moreover, discordances of up to 29% between pre- and post-natal diagnoses of CHD and a limited ability to measure blood flow using echocardiography encourages the development of new techniques to improve prenatal cardiovascular imaging. 6 …”

Section: Introductionmentioning

confidence: 99%

Evaluation of a Portable Doppler Ultrasound Gating Device for Fetal Cardiac MR Imaging: Initial Results at 1.5T and 3T

Kording

Schoennagel

Sousa

et al. 2018

MRMS

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Purpose:Fetal cardiac MRI has the potential to play an important role in the assessment of fetal cardiac pathologies, but it is up to now not feasible due to a missing gating method. The purpose of this work was the evaluation of Doppler ultrasound (DUS) for external fetal cardiac gating with regard to compatibility, functionality, and reliability. Preliminary results were assessed performing fetal cardiac MRI.Methods:An MRI conditional DUS device was developed to obtain a gating signal from the fetal heart. The MRI compatibility was evaluated at 1.5T and 3T using B1 field maps and gradient echo images. The quality and sensitivity of the DUS device to detect the fetal heart motion for cardiac gating were evaluated outside the MRI room in 15 fetuses. A dynamic fetal cardiac phantom was employed to evaluate distortions of the DUS device and gating signal due to electromagnetic interferences at 1.5T and 3T. In the first in vivo experience, dynamic fetal cardiac images were acquired in four-chamber view at 1.5T and 3T in two fetuses.Results:The maximum change in the B1 field and signal intensity with and without the DUS device was <6.5% for 1.5T and 3T. The sensitivity of the DUS device to detect the fetal heartbeat was 99.1%. Validation of the DUS device using the fetal cardiac phantom revealed no electromagnetic interferences at 1.5T or 3T and a high correlation to the simulated heart frequencies. Fetal cardiac cine images were successfully applied and showed good image quality.Conclusion:An MR conditional DUS gating device was developed and evaluated revealing safety, compatibility, and reliability for different field strengths. In a preliminary experience, the DUS device was successfully applied for in vivo fetal cardiac imaging at 1.5T and 3T.

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Discordances Between Pre-Natal and Post-Natal Diagnoses of Congenital Heart Diseases and Impact on Care Strategies

Cited by 51 publications

References 45 publications

The role of regional prenatal cardiac screening for congenital heart disease: A single center experience

The role of regional prenatal cardiac screening for congenital heart disease: A single center experience

Can echocardiographic screening in the early days of life detect critical congenital heart disease among apparently healthy newborns?

Evaluation of a Portable Doppler Ultrasound Gating Device for Fetal Cardiac MR Imaging: Initial Results at 1.5T and 3T

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