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Trends in the Prenatal Detection of Major Congenital Heart Disease in Alberta From 2008–2018

      Abstract

      Objective

      The effect of expanded obstetrical ultrasound cardiac views on the diagnosis of fetal congenital heart disease (CHD) has not been fully examined at a population level. We hypothesized there has been a significant increase in the prenatal detection of CHD in Alberta, particularly for CHD associated with cardiac outflow tract and 3-vessel view abnormalities.

      Methods

      Using provincial databases, we retrospectively identified all fetuses and infants diagnosed between 2008 and 2018 in Alberta with major CHD requiring surgical intervention within the first postnatal year. We evaluated individual lesions and categorized CHDs into the following groups based on the obstetrical ultrasound cardiac views required for detection: (1) 4-chamber view (e.g., hypoplastic left heart syndrome, Ebstein’s anomaly, single ventricle); (2) outflow tract view (e.g., tetralogy of Fallot, d-transposition, truncus arteriosus); (3) 3-vessel or other non-standard cardiac views (e.g., coarctation, anomalous pulmonary veins); and (4) isolated ventricular septal defects using any view.

      Results

      Of 1405 cases of major CHD, 814 (58%) were prenatally diagnosed. Over the study period, prenatal detection increased in all groups, with the greatest increase observed for groups 1 and 2 (75%–88%; P = 0.008 and 56%–79%; P = 0.0002, respectively). Although rates of prenatal detection also increased for groups 3 and 4 (27%–43%; P = 0.007 and 13%–30%; P = 0.04, respectively), fewer than half of the cases in each group were detected prenatally, even in more recent years.

      Conclusions

      While rates of prenatal detection of CHD have significantly improved during the past decade, many defects with abnormal 3-vessel and non-standard views, as well as isolated ventricular septal defects, still go undetected.

      Résumé

      Objectif

      L’effet de l’augmentation des coupes cardiaques à l’échocardiographie obstétricale sur le diagnostic de cardiopathie congénitale fœtale (CCF) n’a pas été pleinement examiné au niveau populationnel. Nous avons émis l’hypothèse d’une augmentation significative de la détection prénatale de la CCF en Alberta, particulièrement pour la CCF associée à des anomalies cardiaques pour les coupes des voies d’éjection et des trois vaisseaux.

      Méthodologie

      À partir des bases de données provinciales albertaines, nous avons identifié rétrospectivement tous les fœtus et nourrissons qui ont reçu, entre 2008 et 2018, un diagnostic de CCF majeure nécessitant une intervention chirurgicale dans la première année de vie. Nous avons évalué chaque lésion et regroupé les CCF en différentes catégories selon les coupes cardiaques requises à l’échocardiographie obstétricale pour la détection : (1) coupe de quatre cavités (p. ex., hypoplasie du cœur gauche, maladie d’Ebstein, ventricule unique); (2) coupe des voies d’éjection (p. ex., tétralogie de Fallot, transposition des gros vaisseaux, tronc artériel commun); (3) coupes de trois vaisseaux ou autres coupes cardiaques non standard (p. ex., coarctation de l’aorte, anomalies des veines pulmonaires); et (4) communications interventriculaires isolées, vues par n’importe quelle coupe.

      Résultats

      Des 1 405 cas de CCF majeure, 814 (58 %) ont fait l’objet d’un diagnostic prénatal. Pendant la période de l’étude, la détection prénatale a augmenté dans tous les groupes, la plus forte augmentation ayant été observée dans les groupes 1 et 2 (75–88 %; p = 0,008 et 56 -79 %; p = 0,0002, respectivement). Même si les taux de détection prénatale ont aussi augmenté dans les groupes 3 et 4, (27–43 %; p = 0,007 et 13–30 %; p = 0,04, respectivement), moins de la moitié des cas dans chaque groupe ont été diagnostiqués avant la naissance, même dans les dernières années.

      Conclusions

      Malgré l’augmentation significative du taux de détection prénatale des CCF au cours des dix dernières années, nombre d’anomalies dans les coupes des trois vaisseaux et non standard ne sont pas détectées. Il en va de même pour les communications interventriculaires isolées.

      Keywords

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