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Conotruncal anomalies in the fetus: Referral patterns and pregnancy outcomes in a dedicated fetal cardiology unit in South India

Publication Type : Journal Article

Thematic Areas : Medical Sciences

Publisher : Annals of Pediatric Cardiology

Source : Annals of Pediatric Cardiology, Volume 6, Number 1, p.15-20 (2013)

Url : is external)

Keywords : absent pulmonary valve, adult, arterial trunk, article, congenital heart malformation, conotruncal anomaly, diagnostic accuracy, Fallot tetralogy, female, fetal electrocardiograph, fetus, gestational age, great vessels transposition, heart right ventricle double outlet, heart surgery, human, India, major clinical study, outcome assessment, patient counseling, patient referral, pediatric cardiology, pregnancy outcome, prenatal diagnosis, pulmonary valve atresia

Campus : Kochi

School : School of Medicine

Department : Paediatric Cardiology

Verified : Yes

Year : 2013

Abstract : Objective: To describe the referral patterns and pregnancy outcomes of fetuses with conotruncal anomalies (CTA) from a fetal cardiology unit in South India. Methods: Records of 68 women identified to have diagnosis of CTA on fetal echocardiography (mean gestational age 26.8 ± 5.9 weeks; range 17-38 weeks) during the period 2008-2011 were reviewed. Results: The most common indication for referral was suspected congenital heart disease during routine antenatal scan (89.7%). The various CTA diagnosed included Tetralogy of Fallot (TOF, 44.1%), Double outlet right ventricle (DORV, 27.9%), Transposition of great vessels (TGA, 8.8%), TOF with pulmonary atresia (TOF-PA, 8.8%), TOF absent pulmonary valve (TOF-APV, 7.4%) and truncus arteriosus (TA, 2.9%). Extra cardiac anomalies were reported in 4 fetuses (7.1%). Pregnancy outcomes included pregnancies not culminating in live-birth (54.4%), delivery at term (41.2%) with 3 patients (4.4%) being lost to follow-up. Proportion of pregnancies not culminating in live-birth lesion wise include: TOF (53.3%), DORV (52.6%), TGA (50%), TOF -APV (80%), TOF-PA (50%), and TA (50%). Twenty-four babies (35.3%) received post-natal cardiac care with 5 (7.4%) undergoing neonatal surgical procedures. Seven babies (10.3%) died in neonatal period, including 2 who underwent surgery. The accuracy of fetal echo was 96.4% for primary lesion and 67.9% for complete segmental diagnosis. Conclusions: Pre-natal diagnosis of CTA, despite a high diagnostic accuracy, prompted utilization of post-natal tertiary cardiac care in a limited proportion of patients, including those with reparable lesions. Focus in developing countries should shift towards earlier referral, improving awareness about treatment options and a comprehensive evaluation for associated anomalies. Copyright © Annals of Pediatric Cardiology 2013.

Cite this Research Publication : Bab Vaidyanathan, Kumar, Sa, Sudhakar, Aa, and Kumar, R. Ka, “Conotruncal anomalies in the fetus: Referral patterns and pregnancy outcomes in a dedicated fetal cardiology unit in South India”, Annals of Pediatric Cardiology, vol. 6, pp. 15-20, 2013.

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