Outcome after prenatal diagnosis of hypoplastic left-heart syndrome: a case series.
BACKGROUND
Traditionally, after prenatal diagnosis of hypoplastic left-heart syndrome (HLHS) couples have been offered termination of pregnancy or comfort care. Success of postnatal surgical options such as the Norwood procedure have been associated with survival of up to 60%. Whether survival is affected by the congenital anomaly being identified prenatally or postnatally remains uncertain.


METHODS
We reviewed all cases of prenatally diagnosed HLHS referred to the Fetal Medicine Unit at Birmingham Women's Hospital over 6 years between 1994 and 1999.


RESULTS
87 cases of HLHS were referred at a median gestational age (95% CI) of 23 (19-37) weeks. Of these, 53 (61%) chose prenatal karyotyping. The overall frequency of abnormal karyotype was found in seven of 59 cases (12%) and associated structural anomalies in 18 of 87 (21%). After counselling, 38 of 87 couples (44%) chose termination of pregnancy. Of the remaining 49 fetuses, 11 (23%) were not considered for postnatal surgery because of parental choice and they died after compassionate care. Of the 36 babies who had surgery postnatally, 12 survived (33%). We recorded a survival rate of 38% for the stage-1 Norwood procedure in the prenatally diagnosed HLHS in our centre. These data suggest that at the point of prenatal detection, the overall survival rate for fetuses with HLHS is 25% (if terminated pregnancies are excluded).


CONCLUSIONS
Fetal echocardiography allows early diagnosis of HLHS and gives clinicians the opportunity to triage this group dependent on prenatal findings, including karyotyping and the exclusion of other structural anomalies. These prospective data provide up-to-date information on the basis of which parents can make decisions.
Brackley
K J
KJ
Division of Reproductive and Child Health, Birmingham Women's and Children's Hospitals, University of Birmingham.
Kilby
M D
MD
Wright
J G
JG
Brawn
W J
WJ
Sethia
B
B
Stumper
O
O
Holder
R
R
Wyldes
M P
MP
Whittle
M J
MJ
D000028:Abortion, Induced; D000328:Adult; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D005313:Fetal Death; D005865:Gestational Age; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000000981:diagnostic imaging / Q000235:genetics / Q000401:mortality / Q000601:surgery; D007231:Infant, Newborn; D007621:Karyotyping; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D015996:Survival Rate; D016216:Ultrasonography, Prenatal