Improved Surgical Outcome After Fetal Diagnosis of Hypoplastic Left Heart Syndrome

• DOI: 10.1161/01.cir.103.9.1269
• Publication Date: 2012-06-12T00:09:32Z
• Authors: Wayne Tworetzky; Doff B. McElhinney; V. Mohan Reddy; Michael M. Brook; Frank L. Hanley; Norman H. Silverman
• Keywords: Age Factors; Pregnancy Outcome; 3. Good health; Cohort Studies; Survival Rate; 03 medical and health sciences; 0302 clinical medicine; Pregnancy; Prenatal Diagnosis; Hypoplastic Left Heart Syndrome; Humans; Female

Background —Hypoplastic left heart syndrome (HLHS) is frequently diagnosed prenatally, but this has not been shown to improve surgical outcome. Methods and Results —We reviewed patients with HLHS between July 1992 March 1999 determine the influence of prenatal diagnosis on preoperative clinical status, outcomes stage 1 surgery, parental decisions regarding care. Of 88 patients, 33 were prenatally 55 after birth. 22 live-born, pregnancy was terminated in 11. who 14 underwent parents elected forego treatment 8. postnatally, 38 17 did because or considerations. Prenatally less likely undergo surgery than birth ( P =0.008). Among live-born infants, there a similar rate nonintervention. survival 75% (39/52). All had survived, whereas only 25 postnatally survived =0.009). Patients lower incidence acidosis =0.02), tricuspid regurgitation =0.001), ventricular dysfunction =0.004). They also need inotropic medications bicarbonate =0.005). Preoperative factors correlating early mortality included postnatal =0.009), more severe =0.03), for inotropes =0.008 0.04), =0.05). Conclusions —Prenatal associated improved status first-stage palliation comparison