Fetal and post-natal diagnosis of major congenital heart disease: Implications for medical and psychological care in the current era

Authors

  • Gary F Sholler,

    Corresponding author
    1. Heart Centre for Children, The Children's Hospital at Westmead, Westmead
    2. Sydney Medical School, The University of Sydney, Sydney
    Search for more papers by this author
    • Authors contributed equally to this work.

  • Nadine A Kasparian,

    1. Heart Centre for Children, The Children's Hospital at Westmead, Westmead
    2. Sydney Medical School, The University of Sydney, Sydney
    3. School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
    Search for more papers by this author
    • Authors contributed equally to this work.

  • Victoria E Pye,

    1. Heart Centre for Children, The Children's Hospital at Westmead, Westmead
    Search for more papers by this author
  • Andrew D Cole,

    1. Heart Centre for Children, The Children's Hospital at Westmead, Westmead
    Search for more papers by this author
  • David S Winlaw

    1. Heart Centre for Children, The Children's Hospital at Westmead, Westmead
    2. Sydney Medical School, The University of Sydney, Sydney
    Search for more papers by this author

Associate Professor Gary Sholler, Heart Centre for Children, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia. Fax: +61 29845 2163; email: garys@chw.edu.au

Abstract

Aim:  The fetal or post-natal diagnosis of major congenital cardiac abnormality has important medical and psychological consequences.

Methods:  We reviewed infants who underwent cardiac surgery in the first year of life at the Heart Centre for Children, The Children's Hospital at Westmead during 2009. The aims of this study were to: (i) examine the key features of cardiac diagnosis and clinical outcome, and (ii) consider how these data can inform priorities for the delivery of clinical services.

Results:  Over the 12-month study period, a first cardiac surgical procedure was performed on 195 infants, with 85 infants (44%) diagnosed in the antenatal period. Of the total sample, a subset of 90 babies (46%) underwent their first procedure in the neonatal period, with 62% having had a fetal diagnosis. Major intracardiac lesions including truncus arteriosus (100%), single ventricular lesions (83%), pulmonary atresia with ventricular septal defect (78%) and transposition of the great arteries (53%) were diagnosed prior to birth. Improved haemodynamic stability at initial presentation was found in those with a fetal diagnosis. The overall mortality rate for all patients was 6.1% at 12 months, with a higher mortality in infants with single ventricle.

Conclusions:  The contemporary paradigm of care for infants with major congenital heart disease requires a multidisciplinary approach to care, with improvements in clinician–clinician and clinician–family communication, and psychological support and education for families. Changes in the allocation of resources are required to meet this model of best practice.

Ancillary