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The impact of prenatal diagnosis on the structure of neonatal cardiac surgery interventions

SOVREMENNAYA PEDIATRIYA. 2015.2(66):28-31; doi 10.15574/SP.2015.66.28

 

The impact of prenatal diagnosis on the structure of neonatal cardiac surgery interventions

 

Zhovnir V. A., Fedevich O. M., Kurkevych A. K.

State Institution «Scientific and Practical Medical Center for Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine», Kiev

 

Objective. To analyze the tendency of change of surgical strategies used in the SI «Scientific and Practical Medical Center for Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine» in neonates during the treatment of the difficult critical congenital heart disease (CHD).

 

Patients and methods. The database of prenatal echocardiography of the critical CHD, structure and results of surgery in neonates operated at the Centre during the 2009–2014yy is analyzed.

 

Results. A total of 935 neonates with critical CHD were operated, in 269 (29%) of them diagnose was made prenatally. The increase in the absolute number of patients operated in the age up to 1 month is observed — from 130 in 2009 y. to 163 in 2014y. At the same time there is a clear tendency in the proportion of prenatally exposed diagnoses from 24% to 42%. The share of primary radical surgical correction of critical CHD increased from 69% in 2009 y. to 79% in 2014y. Postoperative mortality in this group declined from 5.6% in 2009 y. to 3% in 2014y. In 105 (11%) of patients radical correction was carried out in the first hours of life using autologous umbilical cord blood during the surgery. The average number of collected cord blood was 76±21 ml.

 

Conclusions. An increase in the proportion of primary radical correction of defects among surgical interventions and reduction of postoperative mortality among infants with critical CHD is observed. Prenatal diagnosis allows us to optimize the preoperative stage and performs a radical correction of the defect in the early hours of the patient's life using autologous umbilical cord blood.

 

Key words: prenatal diagnosis, neonatal cardiac surgery, autologous umbilical blood.

 

REFERENCES 
1. Федевич ОМ, Жовнір ВА, Часовський КС и др. 2011. Операція артеріального переключення в перші години життя у новонароджених з пренатально встановленим діагнозом транспозиції магістральних судин. Клін хірургія. 9: 47—50.

2. Руденко НМ. 2003.Система невідкладної допомоги дітям першого року життя зі складними вродженими вадами серця. Дис. д. мед. наук. 14.01.04. К.

3. Bonnet D, Coltri A, Butera G et al. 1999. Detection of transposition of the great arteries in fetuses reduces neonatal morbidity and mortality. Circulation. 99: 916—918.

4. Fedevych О, Chasovskyi K, Vorobiova G et al. 2011. Open cardiac surgery in the first hours of life using autologous umbilical cord blood. Eur J Cardiothorac Surg. 40: 985—989.

5. Reddy VM, McElhinney DB, Sagrado T et al. 1999. Results of 102 cases of complete repair of congenital heart defects in patients weighing 700 to 2500 grams. J Thorac Cardio Vasc Surg. 117: 324—331.

6. Sharland G. 1997. Changing impact of fetal diagnosis of congenital heart disease. Arch Dis Child Fetal Neonatal Ed. 77.

7. Levey A, Glickstein JS, Kleinman CS et al. 2010. The Impact of Prenatal Diagnosis of Complex Congenital Heart Disease on Neonatal Outcomes. Pediatr Cardiol. 31(5): 587—597. http://dx.doi.org/10.1007/s00246-010-9648-2; PMid:20165844 PMCid:PMC2889000