先天性心脏病胎儿的预后变化：意大利多中心新研究

Changed outcomes of fetuses with congenital heart disease: new Italian Multicentre study.

作者信息

Fesslova' Vlasta, Brankovic Jelena, Boschetto Chiara, Masini Annaclaudia, Prandstraller Daniela, Perolo Antonella, Ventriglia Flavia, Macerola Silvia, Crepaz Roberto, Romeo Cristina, De Luca Francesco, Previtera Agata, Errico Gabriella

机构信息

aCenter of Fetal Cardiology, Policlinico San Donato IRCSS, Milan bDepartment of Obstetrics and Gynecology, Ospedale Civile di Legnano, Legnano cDepartment of Pediatric Cardiology and Obstetrics and Gynecology, Policlinico S. Orsola IRCCS, Bologna dDepartment of Pediatric Cardiology and Obstetrics and Gynecology, Sapienza University of Rome, Rome eDepartment of Cardiology, Azienda Ospedaliera Bolzano, Bolzano fDepartment of Pediatric Cardiology, Ospedale Ferrarotto, Azienda Vittorio Emanuele, Catania gDepartment of Pediatrics, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.

出版信息

J Cardiovasc Med (Hagerstown). 2015 Aug;16(8):568-75. doi: 10.2459/JCM.0b013e328365c325.

DOI:10.2459/JCM.0b013e328365c325

PMID:24933199

Abstract

OBJECTIVES

To analyse the outcomes of fetuses with congenital heart disease between 2000 and 2005 in comparison to a previous multicentre study regarding the period 1983-1996.

PARTICIPANTS AND METHODS

Data of seven centres were prospectively collected, the inclusion criteria being a confirmed fetal diagnosis after birth or at autopsy and a known follow-up, for at least 6 months after birth. Data of 649 fetuses, median age at diagnosis 24 weeks' gestation (15-37), 340/649 (52.4%) diagnosed before 24 weeks, were analysed.

RESULTS

Sixty seven and 59 cases had chromosomal or extracardiac anomalies (10.3 and 9.1%). Termination of pregnancy was chosen in 21.6% of cases versus 28.9% in the previous study, being significantly lower in cases with early diagnosis (P <0.001). Out of 509 fetuses continuing pregnancy, 23 died in utero (4.5%) and 110 (21.1%) postnatally, versus 43% in the previous study (P <0.0017). Total surgical/postprocedure death occurred in 20.6% (59/287 infants) versus 37% previously (P <0.003), 67 infants being premature and 35 with associated chromosomal or extracardiac anomalies. The current overall mortality rate was higher in cases with chromosomal or extracardiac anomalies (59.5 and 51.35%, respectively, whereas it was 20.1% in isolated congenital heart disease). Overall current survival was 376 of 509 (73.9%) versus 45% in the previous study (P <0.0001).

CONCLUSION

Our data show a reduced overall and surgical mortality, with respect to our previous study, resulting from resulting from an improved perinatal management and treatment of affected fetuses in the more recent era.

摘要

目的

与之前一项关于1983 - 1996年期间的多中心研究相比，分析2000年至2005年患有先天性心脏病胎儿的结局。

参与者与方法

前瞻性收集了七个中心的数据，纳入标准为出生后或尸检时确诊的胎儿诊断以及已知的出生后至少6个月的随访情况。分析了649例胎儿的数据，诊断时的中位孕周为24周（15 - 37周），其中340/649（52.4%）在24周前被诊断。

结果

67例和59例有染色体或心外异常（分别为10.3%和9.1%）。21.6%的病例选择终止妊娠，而之前的研究为28.9%，早期诊断的病例中这一比例显著更低（P<0.001）。在继续妊娠的509例胎儿中，23例死于宫内（4.5%），110例（21.1%）出生后死亡，而之前的研究为43%（P<0.0017）。手术/术后总死亡率为20.6%（59/287例婴儿），而之前为37%（P<0.003），67例婴儿为早产，35例伴有相关染色体或心外异常。目前，染色体或心外异常病例的总体死亡率更高（分别为59.5%和51.35%，而孤立性先天性心脏病的死亡率为20.1%）。目前总体生存率为509例中的376例（73.9%），而之前的研究为45%（P<0.0001）。