Analysis of Clinical Outcome of Multidisciplinary Consultation in 387 Cases of Fetal Congenital Heart Disease

doi:10.12280/gjfckx.20210648

Abstract

Abstract:

Objective：To explore the clinical management and experience of fetal congenital heart disease (CHD) under multidisciplinary consultation management mode. Methods：A total of 387 singleton pregnant women were selected from Henan Provincial People′s Hospital from January 2017 to January 2020, who underwent multi-disciplinary consultation and genetic examination after echocardiography of fetal CHD, the classification and management of fetal CHD were analyzed retrospectively. Results：The common CHD includes permanent left superior vena cava, aortic coarctation, ventricular septal defect, transposition of the great artery, endocardial pad defect, tetralogy of Fallot, etc. According to the echocardiography, the complexity of CHD and the presence or absence of extracardiac abnormalities, the fetuses with CHD were divided into three groups: single CHD group (132 cases), multiple CHD group (159 cases), and combined extracardiac CHD group (96 cases), Genetic examination found that 57 cases of chromosome abnormality were induced labor. Finally, 270 cases (69.8%) pregnant women and their family members chose to terminate pregnancy, 117 cases (30.2%) continued pregnancy, of which 8 cases were lost to follow-up, and the remaining 109 cases were followed up. Among the follow-up group, 2 cases received intrauterine treatment, 3 cases died intrauterine, 8 cases died after birth, 43 cases received surgical treatment after birth, of which 5 cases died after operation, 38 cases had good prognosis, and the remaining 53 cases of CHD were generally in good condition during follow-up observation. Conclusions：Prenatal multidisciplinary consultation is helpful to the management of fetal CHD, simplify the procedure of prenatal consultation, provide more reasonable treatment advice for pregnant women, avoid blind induction of labor or continued pregnancy, guide the follow-up and treatment after birth, and improve the prognosis of retained fetus.

Key words: Ultrasonography,prenatal, Heart defects,congenital, Pregnancy outcome, Follow-up studies, Multidisciplinary consultation

JIAO Xiao-jie, LIU Kan, WANG Qiu-ming, SONG Wan-yu, ZHANG Jing-li, LI Lin-yuan, WAN Ping, WU Hai-ying. Analysis of Clinical Outcome of Multidisciplinary Consultation in 387 Cases of Fetal Congenital Heart Disease[J]. Journal of International Obstetrics and Gynecology, 2022, 49(1): 101-105.

Figures/Tables 5

References 18

[1]	El-Gilany AH, Yahia S, Wahba Y. Prevalence of congenital heart diseases in children with Down syndrome in Mansoura, Egypt: a retrospective descriptive study[J]. Ann Saudi Med, 2017, 37(5):386-392. doi: 10.5144/0256-4947.2017.386. doi: 10.5144/0256-4947.2017.386
[2]	Hopkins MK, Dugoff L, Kuller JA. Congenital Heart Disease: Prenatal Diagnosis and Genetic Associations[J]. Obstet Gynecol Surv, 2019, 74(8):497-503. doi: 10.1097/OGX.0000000000000702. doi: 10.1097/OGX.0000000000000702 pmid: 31418452
[3]	Cruz-Lemini M, Nieto-Castro B, Luna-Garcia J, et al. Prenatal diagnosis of congenital heart defects: experience of the first Fetal Cardiology Unit in Mexico[J]. J Matern Fetal Neonatal Med, 2021, 34(10):1529-1534. doi: 10.1080/14767058.2019.1638905. doi: 10.1080/14767058.2019.1638905
[4]	Qiu X, Weng Z, Liu M, et al. Prenatal diagnosis and pregnancy outcomes of 1492 fetuses with congenital heart disease: role of multidisciplinary-joint consultation in prenatal diagnosis[J]. Sci Rep, 2020, 10(1):7564. doi: 10.1038/s41598-020-64591-3. doi: 10.1038/s41598-020-64591-3
[5]	Tutunji L, Thekrallah F, Basha A, et al. Prenatal detection of fetal heart disease at Jordan University Hospital: early experience in a developing country[J]. Cardiol Young, 2019, 29(8):1072-1077. doi: 10.1017/S1047951119001550. doi: 10.1017/S1047951119001550 pmid: 31287035
[6]	Sillesen AS, Raja AA, Pihl C, et al. Copenhagen Baby Heart Study: a population study of newborns with prenatal inclusion[J]. Eur J Epidemiol, 2019, 34(1):79-90. doi: 10.1007/s10654-018-0448-y. doi: 10.1007/s10654-018-0448-y
[7]	Luo S, Meng D, Li Q, et al. Genetic Testing and Pregnancy Outcome Analysis of 362 Fetuses with Congenital Heart Disease Identified by Prenatal Ultrasound[J]. Arq Bras Cardiol, 2018, 111(4):571-577. doi: 10.5935/abc.20180144. doi: 10.5935/abc.20180144
[8]	Zhang YF, Zeng XL, Zhao EF, et al. Diagnostic Value of Fetal Echocardiography for Congenital Heart Disease: A Systematic Review and Meta-Analysis[J]. Medicine(Baltimore), 2015, 94(42):e1759. doi: 10.1097/MD.0000000000001759. doi: 10.1097/MD.0000000000001759
[9]	Cai M, Huang H, Su L, et al. Fetal congenital heart disease: Associated anomalies, identification of genetic anomalies by single-nucleotide polymorphism array analysis, and postnatal outcome[J]. Medicine(Baltimore), 2018, 97(50):e13617. doi: 10.1097/MD.0000000000013617. doi: 10.1097/MD.0000000000013617
[10]	Pavlicek J, Gruszka T, Kapralova S, et al. Associations between congenital heart defects and genetic and morphological anomalies. The importance of prenatal screening[J]. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2019, 163(1):67-74. doi: 10.5507/bp.2018.049. doi: 10.5507/bp.2018.049
[11]	Huang H, Cai M, Wang Y, et al. SNP Array as a Tool for Prenatal Diagnosis of Congenital Heart Disease Screened by Echocardiography: Implications for Precision Assessment of Fetal Prognosis[J]. Risk Manag Healthc Policy, 2021, 14:345-355. doi: 10.2147/RMHP.S286001. doi: 10.2147/RMHP.S286001
[12]	Kim ST, Song J, Huh J, et al. The Effect of Multidisciplinary Approach on the Birth Rate of Fetuses with Prenatally Diagnosed Congenital Heart Disease[J]. J Korean Med Sci, 2019, 34(24):e170. doi: 10.3346/jkms.2019.34.e170. doi: 10.3346/jkms.2019.34.e170
[13]	Pavlicek J, Gruszka T, Polanska S, et al. Parents' request for termination of pregnancy due to a congenital heart defect of the fetus in a country with liberal interruption laws[J]. J Matern Fetal Neonatal Med, 2020, 33(17):2918-2926. doi: 10.1080/14767058.2018.1564029. doi: 10.1080/14767058.2018.1564029 pmid: 30646776
[14]	姜振林, 刘育宏, 吴忠仕, 等. 心外科产前咨询225例先天性心脏病胎儿[J]. 中南大学学报(医学版), 2020, 45(7):812-818. doi: 10.11817/j.issn.1672-7347.2020.190198. doi: 10.11817/j.issn.1672-7347.2020.190198
[15]	印荷杨, 赵俊. 医院多学科团队研究[J]. 南京医科大学学报(社会科学版), 2019, 19(6):476-479. doi: 10.7655/NYDXBSS20190612. doi: 10.7655/NYDXBSS20190612
[16]	Luks FI, Carr SR, Feit LR, et al. Experience with a multidisciplinary antenatal diagnosis and management model in fetal medicine[J]. J Matern Fetal Neonatal Med, 2003, 14(5):333-337. doi: 10.1080/jmf.14.5.333.337. doi: 10.1080/jmf.14.5.333.337
[17]	Ge CJ, Mahle AC, Burd I, et al. Fetal CHD and perinatal outcomes[J]. Cardiol Young, 2020, 30(5):686-691. doi: 10.1017/S1047951120000785 doi: 10.1017/S1047951120000785
[18]	邱秀青, 翁宗杰, 刘敏, 等. 胎儿先天性心脏病产前诊断及多学科联合会诊分析[J]. 福建医药杂志, 2020, 42(6):51-54.

CHD分类	例（构成比）	CHD分类	例（构成比）
永存左上腔静脉	24（6.2%）	交叉肺动脉	9（2.3%）
法洛四联症	18（4.7%）	主动脉弓离断	8（2.1%）
主动脉缩窄	12（3.1%）	肺动脉瓣狭窄	8（2.1%）
室间隔缺损	12（3.1%）	肺动脉闭锁	4（1.0%）
大动脉转位	12（3.1%）	房间隔缺损	2（0.5%）
心内膜垫缺损	12（3.1%）	心包畸胎瘤	1（0.3%）
完全性肺静脉异位引流	9（2.3%）	阵发性室上性心动过速	1（0.3%）

CHD分类	例（构成比）	CHD分类	例（构成比）
永存左上腔静脉	24（6.2%）	交叉肺动脉	9（2.3%）
法洛四联症	18（4.7%）	主动脉弓离断	8（2.1%）
主动脉缩窄	12（3.1%）	肺动脉瓣狭窄	8（2.1%）
室间隔缺损	12（3.1%）	肺动脉闭锁	4（1.0%）
大动脉转位	12（3.1%）	房间隔缺损	2（0.5%）
心内膜垫缺损	12（3.1%）	心包畸胎瘤	1（0.3%）
完全性肺静脉异位引流	9（2.3%）	阵发性室上性心动过速	1（0.3%）

CHD分类	例（构成比）	CHD分类	例（构成比）
脉络丛囊肿	15（3.9%）	胸腺缺如或发育不良	6（1.6%）
侧脑室增宽	13（3.4%）	内脏反位	6（1.6%）
腹腔或胸腔积液	12（3.1%）	胼胝体发育不良	6（1.6%）
四肢或脊柱异常	12（3.1%）	肾脏发育不良	4（1.0%）
胎儿生长受限	9（2.3%）	脐膨出	3（0.8%）
肾盂分离	8（2.1%）	水平肝	2（0.5%）

CHD分类	例（构成比）	CHD分类	例（构成比）
脉络丛囊肿	15（3.9%）	胸腺缺如或发育不良	6（1.6%）
侧脑室增宽	13（3.4%）	内脏反位	6（1.6%）
腹腔或胸腔积液	12（3.1%）	胼胝体发育不良	6（1.6%）
四肢或脊柱异常	12（3.1%）	肾脏发育不良	4（1.0%）
胎儿生长受限	9（2.3%）	脐膨出	3（0.8%）
肾盂分离	8（2.1%）	水平肝	2（0.5%）

组别	n	年龄（岁）	诊断孕周（周）	遗传检查结果异常	终止妊娠率
单一CHD组	132	30.00±4.44	25.07±3.17	11（8.3）*	91（68.9）
多发CHD组	159	30.04±3.96	26.43±4.27	19（11.9）*	111（69.8）
合并心外异常CHD组	96	32.16±5.24	27.16±3.85	27（28.1）	68（70.8）
F或χ²		2.751	3.021	18.994	0.095
P		0.068	0.052	0.000	0.954