| Impact of prenatal diagnosis and anatomical subtype on outcome in double outlet right ventricle. | |
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MedLine Citation:
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PMID: 20934564 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: We sought to investigate the influence of prenatal diagnosis and risk factors for adverse outcomes in double outlet right ventricle (DORV) not associated with heterotaxy. METHODS: Patients with a pre or postnatal diagnosis of DORV from 2000 to 2007 were identified and classified into 3 subgroups: subaortic ventricular septal defect (VSD) and normal great artery (GA) arrangement (=VSD type), tetralogy of Fallot type, and transposition of the GA type (=TGA type). Patients with heterotaxy, atrioventricular septal defect, valve atresia, and ventricular hypoplasia were excluded. Complex postnatal care was defined as prematurity, need for prostaglandins, surgical repair <2 months, or univentricular palliation. Risk factors for complex postnatal care and demise were sought in multivariable logistic regression models. One hundred fort-five patients were included (93 prenatal, 52 postnatal). RESULTS: There were 24 pregnancy terminations and 7 in utero deaths. Fetal demise was associated with abnormal karyotype (odds ratio [OR] 1.9, P = .01), any tricuspid valve regurgitation (OR 10.6, P = .01), and hydrops (OR 23.8, P = .02). Of 114 liveborn patients, 23 were tetralogy-type, 67 VSD-type, and 24 TGA-type patients. Postnatal survival of liveborn patients at 1 year was similar in pre- versus postnatally diagnosed patients (84% vs 85%). Abnormal GA relationship (OR 2.9, P = .02), subpulmonary VSD (OR 6.0, P = .001), unobstructed pulmonary blood flow at birth (OR 2.8, P = .05), and aortic coarctation (OR 9.0, P = .007) were associated with suboptimal postsurgical outcomes. CONCLUSION: Double outlet right ventricle, even without heterotaxy, is associated with complex postnatal care and high risk of early demise. Morphologic subtype, irrespective of pre- or postnatal diagnosis, is a major determinant of outcome. |
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Authors:
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Maria E Lagopoulos; Cedric Manlhiot; Brian W McCrindle; Edgar T Jaeggi; Mark K Friedberg; Lynne E Nield |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: American heart journal Volume: 160 ISSN: 1097-6744 ISO Abbreviation: Am. Heart J. Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-10-11 Completed Date: 2010-10-28 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0370465 Medline TA: Am Heart J Country: United States |
Other Details:
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Languages: eng Pagination: 692-700 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2010 Mosby, Inc. All rights reserved. |
Affiliation:
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Hospital for Sick Children, Labatt Family Heart Centre, University of Toronto, Toronto, Ontario, Canada. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Cardiac Surgical Procedures
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methods Diagnosis, Differential Double Outlet Right Ventricle / surgery, ultrasonography* Female Follow-Up Studies Humans Infant Mortality / trends Infant, Newborn Ontario / epidemiology Pregnancy Pregnancy Outcome Severity of Illness Index Time Factors Ultrasonography, Prenatal / methods* |
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