Jill Combs

Perinatal and early surgical outcome for the fetus with hypoplastic left heart syndrome: a 5-year single institutional experience.

To review our experience with the prenatal diagnosis of hypoplastic left heart syndrome (HLHS). Our goal was to establish the benchmark for perinatal and early surgical outcome in the current era, from a center with an aggressive surgical approach and a cohort with a high level of intention‐to‐treat.

Anatomic variability and outcome in prenatally diagnosed absent pulmonary valve syndrome.

BACKGROUND We sought to describe current outcomes and risk factors for mortality for fetuses diagnosed with absent pulmonary valve syndrome (APV). Fetuses with APV were divided into two cohorts, those with underlying tetralogy of Fallot (TOF/APV) and those without underlying TOF and either an intact ventricular septum or small ventricular septal defect (APV/IVS). METHODS The fetal echocardiographic database was reviewed from January 1, 2001, until June 1, 2010, and all subjects with a diagnosis of APV were included. Multiple clinical and fetal echocardiographic measurements were recorded. Statistical analysis was performed by χ2 analysis and t tests. Survival analysis was performed by Kaplan-Meier analysis. Significant relationships between variables were explored by regression analysis. Significance was set at p=0.05. RESULTS The cohort consisted of 15 fetuses with TOF/APV and 6 fetuses with APV/IVS. There were no fetal demises in either cohort. Survival to birth was 71% in the TOF/APV cohort and 83% in the APV/IVS cohort (p=0.62). Of subjects born alive, survival was 80% for both cohorts (p=0.95). However, in the APV/IVS cohort, transplantation-free survival was only 20%. Underlying single-ventricle physiology strongly predicted those who underwent heart transplantation (p=0.003, R2=0.50). For the entire APV cohort, left ventricular dysfunction (p=0.005, R2=0.41) and a higher pulmonary artery valve-to-aortic valve ratio (p=0.02, R2=0.34) predicted mortality. CONCLUSIONS Postnatal outcomes continue to improve for fetuses with APV syndrome. Left ventricular dysfunction and higher pulmonary artery valve-to-aortic valve ratio accurately predict postnatal mortality for fetuses with APV.

OP04.02: Serial prenatal counseling reduces traumatic stress in mothers carrying a fetus with congenital heart disease

LS-SVM also significantly outperformed logistic regression, though with a smaller AUC difference of 0.0011 (P-value < 0.001). Conclusions: LS-SVM with linear kernel outperformed logistic regression across different subsets of differing sizes obtained. LSSVM was especially beneficial for modeling patient groups with small sizes. The analysis showed that in order to obtain near constant steady-state performance, around 500 patients are required for logistic regression, whereas LS-SVM required slightly fewer. These preliminary results may have important implications for other areas where the minimal number of patients to optimally train predictive models is unknown.

MATERNAL PSYCHOLOGICAL STRESS AFTER PRENATAL DIAGNOSIS OF CONGENITAL HEART DISEASE

Prenatal diagnosis of congenital heart disease (CHD) may be beneficial in many ways but it can also increase maternal stress, which may negatively impact both maternal and fetal well-being. Our study objective is to characterize the type and degree of maternal stress incurred by prenatal diagnosis

OC173: Absent pulmonic or aortic valve leaflet syndrome in the fetus: Prenatal diagnosis and outcome of an uncommon anomaly

Objectives: Transposition of the great arteries (TGA) represents a neonatal emergency. In 1999, it has been demonstrated that prenatal diagnosis improves outcome, but since then these results had not been confirmed by other centers. The aim of this study is to assess whether prenatal diagnosis of TGA has any impact on short-term outcome. Methods: We report our results over the last 14 years (1995–2008), on a series of 252 cases of TGA, including 208 cases diangnosed postnatally and 39 cases diagnosed prenatally. Cases with extra-cardiac anomalies and those with contraindications to the switch operation were excluded from the study. Variables considered included: age at admission, intubation, Rashkind septostomy, age at surgery, pre-and post-operative mortality, 1 month survival. Statistics were performed with the SPSS package. Results: Gestational age at delivery, birth weight, Apgar Score, coronary arteries anatomical pattern, time of total circulatory support and length of stay in ICU did not significantly differ between the groups.