THE IMPACT OF PRENATAL DIAGNOSIS ON THE LONG-TERM OUTCOME OF CHILDREN WITH CONGENITAL HEART DISEASE

Purpose: Congenital heart defects represent one of the major causes of infant morbidity and mortality. Intrauterine identification of congenital heart defects allows optimal postnatal management of the neonates including delivery in a tertiary centre permitting immediate early interventions. However the impact of prenatal diagnosis on the long-term outcome of these infants is still under debate.

Methods and Materials: We present the results of a study investigating the long-term outcome of infants with congenital heart disease diagnosed intrauterine in comparison to infants, in whom the diagnosis was achieved postnatally. To allow comparability care was taken to only include cases with simple cardiac lesions. These comprise transposition of the great arteries, pulmonary atresia, tetralogy of Fallot, as well as atrioventricular septal defects. Both children with complex cardiac defects and extra-cardiac lesions were excluded. Prenatal diagnosis as well as postnatal intervention were performed in a single institution (Charité Campus Virchow / Deutsches Herzzentrum Berlin, Germany).

Results: Preliminary results: 228 infants were included in the study. 48 cases had a prenatal diagnosis. The comparative group consisted of 180 representative cases with postnatal diagnosis. The maximum follow up reached 130 months. Data of various outcome criteria will be presented. These include first intervention parameters such age at diagnosis, preoperative clinical status of the infant, age at first therapeutic surgery, surgical complications, duration of intensive care. Long term morbidity is assessed by developmental factors (e.g. body height and weight), clinical symptoms related to the heart disease, dependency to cardiac drugs, echocardiography results, duration of over all- hospitalisation as well as number of secondary interventions necessary. Long-term mortality is calculated.

Conclusions: This study is considered to demonstrate the importance of intrauterine identification of severe cardiac anomalies for the outcome of the infants.