Congenital Heart DiseaseComparison of outcome when hypoplastic left heart syndrome and transposition of the great arteries are diagnosed prenatally versus when diagnosis of these two conditions is made only postnatally☆
Section snippets
Study design and patient selection
We retrospectively identified all neonates with the prenatal or postnatal diagnosis of HLHS or TGA encountered at the Children’s Hospital, Boston, Massachusetts, from January 1988 to May 1996. To assess the impact of the prenatal diagnosis on preoperative mortality associated with HLHS and TGA, we compared the number of preoperative deaths among neonates with a prenatal diagnosis of HLHS or TGA with those in whom the diagnosis was made after birth. Medical records were reviewed to document the
Results
From January 1988 to May 1996, 217 neonates with the diagnosis of HLHS were encountered at Children’s Hospital. Of these, 39 (18%) were diagnosed prenatally. Thirty (77%) of the prenatally diagnosed neonates, including 2 premature neonates and 1 with Turner syndrome, and 156 (88%) of those with a postnatal diagnosis underwent the Norwood operation (stage I palliation).
During the study period, 422 neonates with the diagnosis of TGA were managed at our institution. Sixteen (4%) were prenatally
Discussion
Postnatal survival in newborns with critical congenital heart disease largely depends on the timely initiation of specific treatment.4, 5, 6 Prenatal diagnosis followed by delivery at a tertiary care institution with an expertise in management of newborns with heart disease allows timely institution of specific treatment. It is not clear, however, whether this early resuscitation translates into reduced mortality and morbidity, at least for infants referred to a tertiary care center.
In the
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This study was supported in part by the Kobren Fund, New Delhi, India; AN American Heart Association, Massachusetts Affiliate Physician-Investigator Fellowship Award, and by Grants HL 41786, RR02172, and P30-HD18655 from the National Institutes of Health, Bethesda, Maryland.
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Current address: Amrita Institute of Medical Sciences, Elamakkara PO, Kochi 682026, Kerala, India.