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Perinatal and early surgical outcome for the fetus with hypoplastic left heart syndrome: a 5‐year single institutional experience
Author(s) -
Rychik J.,
Szwast A.,
Natarajan S.,
Quartermain M.,
Donaghue D. D.,
Combs J.,
Gaynor J. W.,
Gruber P. J.,
Spray T. L.,
Bebbington M.,
Johnson M. P.
Publication year - 2010
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.7674
Subject(s) - medicine , hypoplastic left heart syndrome , norwood procedure , prenatal diagnosis , fetus , cohort , pediatrics , surgery , pregnancy , heart disease , biology , genetics
Objectives To review our experience with the prenatal diagnosis of hypoplastic left heart syndrome (HLHS). Our goal was to establish the benchmark for perinatal and early surgical outcome in the current era, from a center with an aggressive surgical approach and a cohort with a high level of intention‐to‐treat. Methods Outcome was assessed in fetuses with HLHS following stratification into high‐risk and standard‐risk categories. High risk was defined as the presence of any of the following: extracardiac, genetic or chromosomal anomalies; prematurity of < 34 weeks' gestation; additional cardiac findings such as intact or highly restrictive atrial septum, severe degree of tricuspid regurgitation or severe ventricular dysfunction. Standard risk was defined as absence of these risk factors. Results Of 240 fetuses evaluated over 5 years, 162 (67.5%) were in the standard‐risk group and 78 (32.5%) were in the high‐risk group. Of the 240 sets of parents, 38 (15.8%) chose termination or non‐intervention at birth at initial prenatal counseling and 185 of the neonates (77.1%) underwent first‐stage Norwood surgery with 155 surviving and 30 deaths, giving an overall Norwood operative survival of 83.8%. Breakdown by risk class reveals a significant Norwood operative survival advantage for the standard‐risk group (92.8%) over the high‐risk group (56.5%) ( P < 0.001). Conclusions Following prenatal diagnosis of HLHS, families should be strongly encouraged to undertake comprehensive prenatal evaluation in order to obtain an accurate prognosis. One‐third have additional risk factors that limit survival outcome, however two‐thirds do not and have an excellent chance of early survival. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.