Fuchs I B, Müller H, Abdul-Khaliq H, Harder T, Dudenhausen J W, Henrich W
Department of Obstetrics, Charité C. Virchow, Berlin, Germany.
Department of Pediatric Cardiology, German Heart Centre Berlin, Berlin, Germany.
Ultrasound Obstet Gynecol. 2007 Jan;29(1):38-43. doi: 10.1002/uog.3900.
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.
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.
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.
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.
比较产前诊断与产后诊断的孤立性先天性心脏病患儿介入治疗后的即时和长期结果。
这是一项回顾性研究，对10年间收入我院儿科心脏病科的257例患儿进行研究，这些患儿患有四种不同的心脏病变之一：大动脉转位、房室管缺损、法洛四联症和肺动脉闭锁；208例为产后诊断，49例为产前诊断。两组患者的治疗方法相同。
产后组入院时的中位年龄为22天，产前组为10天。产前组术前氧饱和度中位数较高（P=0.07），术前心力衰竭病例较少（P=0.03），术前动脉导管关闭病例较少（P=0.04），术后机械通气中位持续时间较短（P=0.03），再次手术需求较少（P=0.02），重症监护病房中位住院时间较短（P=0.05）。产前组术后生存率为96%，产后组为90%。长期生存评估显示，产前组无导管介入间隔时间较长（P=0.03）。在1年随访时，产前组残余心功能受损的发生率低于产后组（P=0.04）。最大随访时的总体生存率，产前组为92%，产后组为84%。
孤立性先天性心脏病的产前诊断可使患儿在更稳定的状态下接受手术，且短期和长期发病率及死亡率较低。
