Samenhang van prenatale echografische diagnosen en bevindingen bij obductie of bij neonatale operatie wegens structurele congenitale hartafwijkingen; retrospectieve analyse

To determine the contribution of the prenatal ultrasound diagnosis of structural congenital heart defects to the care of patients requiring surgery for their condition in the neonatal period.

Design

Retrospective.

Method

During the period January 1991-June 1999, data were collected from two groups of children. One group had a structural heart defect diagnosed prenatally and the other underwent a neonatal operation due to a heart defect. In the prenatal group, the management and follow-up were analysed, whilst in the surgery group, the extent to which ultrasound investigation had been performed and whether there was a relationship between prenatal diagnosis and the severity of acidosis were analysed.

Results

A structural heart defect was found through prenatal ultrasound in 170 children and 64 of these prenatally diagnosed patients died before or immediately after birth, or the pregnancy was aborted. 14 underwent surgery within 31 days post partum. This last category formed an overlap with the surgery group. The surgery group contained 191 patients, who required surgery in the neonatal period, including 24 from the prenatal group. In total, 87 had no prenatal diagnosis. In the group with a prenatal diagnosis pre-operative lactate values were significantly lower.

Conclusion

The heart defect was only diagnosed prenatally in 13 of the patients from the surgery group, although this would have been technically feasible in 46. Better prenatal diagnosis of heart disease could contribute to a better counselling of parents in their choice between abortion, conservative treatment or emergency surgery. In the case of emergency surgery, prenatal detection might lead to a decrease in morbidity and mortality.