Immediate and long-term outcomes in children with prenatal diagnosis of selected isolated congenital heart defects

Objectives: To compare the immediate postinterventional and long-term outcomes of children with a prenatal and those with a postnatal diagnosis of isolated congenital heart defects.

Methods: This was a retrospective study of 257 children admitted over a 10-year period to our pediatric cardiology unit with one of four different cardiac lesions: transposition of the great arteries, atrioventricular canal defect, tetralogy of Fallot and pulmonary atresia; 208 were diagnosed postnatally and 49 prenatally. Management was identical in the two patient groups.

Results: The median age at admission was 22 days in the postnatal group and 10 days in the prenatal group. In the prenatal group there was a higher median preoperative O2 saturation level (P=0.07), fewer cases of preoperative cardiac failure (P=0.03), fewer cases of preoperative closure of the duct (P=0.04), a shorter median duration of postoperative mechanical ventilation (P=0.03), less need for resurgery (P=0.02) and a shorter median duration of stay in the intensive care unit (P=0.05). Postoperative survival was 96% in the prenatal group and 90% in the postnatal group. Assessment of long-term survival revealed a longer catheter intervention-free interval in the prenatal group (P=0.03). At the 1-year follow-up, residual impaired cardiac function was less frequent in the prenatal than in the postnatal group (P=0.04). Overall survival at maximum follow-up was 92% in the prenatal and 84% in the postnatal group.

Conclusions: Prenatal diagnosis of isolated congenital heart defects allows admission for surgery in a more stable condition and is associated with lower short-term and long-term morbidity and mortality.