Prenatal diagnosis of functionally univentricular heart, associations and perinatal outcomes

Prenat Diagn. 2016 Jun;36(6):545-54. doi: 10.1002/pd.4821. Epub 2016 May 10.

Abstract

Objective: Functionally univentricular hearts (UVHs) represent cardiac anomalies in which either the pulmonary or systemic circulation cannot be supported independently. The purpose of our study was to determine perinatal outcomes after prenatal diagnosis of functionally UVH.

Methods: We retrospectively evaluated patients who presented between 2008 and June 2015 in our centre and in prenatal practice praenatal.de in Cologne. We included double inlet left ventricle (DILV), tricuspid valve atresia (TA), pulmonary valve atresia and intact ventricular septum (PA:IVS), unbalanced atrioventricular septal defect (AVSD), heterotaxy, hypoplastic left heart syndrome (HLHS) and hypoplastic left heart complex (HLHC).

Results: Of initially 155 patients, 128 were liveborn (82.6%). Ten neonates (7.8%) were lost to follow-up, in three (2.5%) neonates, parents decided for compassionate care. Overall survival after prenatal diagnosis of functionally UVH was 67.1%, and 90.4% on an intention-to-treat basis. Survival after surgery reached 93.7%. The majority of deaths occurred within the group of dominant RV (10/74, 13.5%). High risk HLHS with restrictive foramen ovale was associated with the lowest survival rate (13/17, 76.5%) with significant difference compared to survival rate in dominant LV (40/41, 97.6%, p < 0.05).

Conclusion: These results should be explained to parents to ensure informed decisions and counselling. © 2016 John Wiley & Sons, Ltd.

MeSH terms

  • Abnormalities, Multiple / epidemiology*
  • Adolescent
  • Adult
  • Female
  • Germany / epidemiology
  • Heart Defects, Congenital / diagnostic imaging
  • Heart Defects, Congenital / mortality*
  • Heart Defects, Congenital / surgery
  • Heart Septal Defects / diagnostic imaging
  • Heart Septal Defects / mortality
  • Heart Septal Defects / surgery
  • Heart Ventricles / abnormalities*
  • Heart Ventricles / diagnostic imaging
  • Heterotaxy Syndrome / diagnostic imaging
  • Heterotaxy Syndrome / mortality
  • Heterotaxy Syndrome / surgery
  • Humans
  • Hypoplastic Left Heart Syndrome / diagnostic imaging
  • Hypoplastic Left Heart Syndrome / mortality
  • Hypoplastic Left Heart Syndrome / surgery
  • Infant, Newborn
  • Lost to Follow-Up
  • Male
  • Middle Aged
  • Pregnancy
  • Pulmonary Atresia / diagnostic imaging
  • Pulmonary Atresia / mortality
  • Pulmonary Atresia / surgery
  • Retrospective Studies
  • Survival Rate
  • Tricuspid Atresia / diagnostic imaging
  • Tricuspid Atresia / mortality
  • Tricuspid Atresia / surgery
  • Ultrasonography, Prenatal
  • Young Adult

Supplementary concepts

  • Atrioventricular Septal Defect