Changing spectrum and outcome of 705 fetal congenital heart disease cases: 12 years, experience in a third-level center.
BACKGROUND
Congenital heart diseases are the most common prenatal and postnatal malformations. Nowadays, fetal echocardiography is a widely practiced technique; however, the impact of prenatal diagnosis on prognosis of the newborns affected by congenital heart disease remains uncertain.


OBJECTIVE
To assess the outcome and the changes in the spectrum of prenatally detected congenital heart disease in our tertiary care centre in 12 years of activity (1995-2006).


RESULTS
We detected 705 congenital heart diseases: 32% (223) were associated with extracardiac or chromosomal anomalies or both, and 68% (482) were isolated. Termination of pregnancy was chosen in 81% for associated anomalies and 37% for isolated anomalies (P<0.001). Of these, more than one-third occurred in hypoplasic left heart cases. The general survival rate was 72%; it was significantly lower in the group with associated heart diseases (46 vs. 80%, P<0.001). Over 12 years we noticed a reduction in the number of multimalformed fetuses and of the hypoplasic left heart cases, and a higher number of aortic arch anomalies detected. During the past 6 years of activity the survival rate obtained has significantly increased (55 to 84%, P<0.05), the termination rate has significantly decreased (35 to 14%, P<0.001) and the number of neonatal deaths has significantly decreased (39 to 10%, P<0.001).


CONCLUSIONS
The survival and the voluntary termination of fetuses with prenatally detected congenital heart diseases are strongly influenced by disease severity and by associated extracardiac or chromosomal anomalies, or both. Over 12 years, the spectrum of fetal congenital heart disease has changed and their outcome has significantly improved.
Russo
Maria G
MG
Division of Pediatric Cardiology and Pediatric Cardiac Surgery, Second University, Monaldi Hospital, Naples, Italy.
Paladini
Dario
D
Pacileo
Giuseppe
G
Ricci
Concetta
C
Di Salvo
Giovanni
G
Felicetti
Maria
M
Di Pietto
Laura
L
Tartaglione
Antonio
A
Palladino
Maria T
MT
Santoro
Giuseppe
G
Caianiello
Giuseppe
G
Vosa
Carlo
C
Calabrò
Raffaele
R
D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging; D000025:Abortion, Eugenic; D005260:Female; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D011247:Pregnancy; D015995:Prevalence; D016216:Ultrasonography, Prenatal