Qu Yanji, Wen Shusheng, Liu Xiaoqing, Pan Wei, Han Fengzhen, Mai Jinzhuang, Ou Yanqiu, Nie Zhiqiang, Gao Xiangmin, Wu Yong, Ohye Richard G, Chen Jimei, Zhuang Jian
1Department of Epidemiology,Guangdong Cardiovascular Institute,Guangdong Provincial Key Laboratory of South China Structural Heart Disease,Guangdong General Hospital,Guangdong Academy of Medical Sciences,Guangzhou,Guangdong,China.
2Department of Cardiac Surgery,Guangdong Cardiovascular Institute,Guangdong Provincial Key Laboratory of South China Structural Heart Disease,Guangdong General Hospital,Guangdong Academy of Medical Sciences,Guangzhou,Guangdong,China.
Cardiol Young. 2018 Jan;28(1):66-75. doi: 10.1017/S1047951117001615. Epub 2017 Aug 8.
The aim of this study was to explore perinatal and early postnatal outcomes in fetuses with prenatally diagnosed d-transposition of the great arteries and impacts of standardised prenatal consultation.
All fetuses with prenatally diagnosed d-transposition of the great arteries prospectively enrolled at South China cardiac centre from 2011 to 2015. Standardised prenatal consultation was introduced in 2013 and comprehensive measures were implemented, such as establishing fetal CHD Outpatient Consultation Service, performing standard prenatal consultation according to specifications, and establishing a multidisciplinary team with senior specialists performing in-person consultations. Continuous follow-up investigation was conducted. Perinatal and postnatal outcomes were compared before and after consultation including live birth, elective termination of pregnancy, spontaneous fetal death, stillbirths, referral for surgery, and survival.
In all, 146 fetuses were enrolled with 41 (28%) lost to follow-up. Among 105 remaining fetuses, 29 (28%) were live births and 76 (72%) were terminated. After consultation, live birth rate was higher (50 versus 33%) and termination rate was lower (50 versus 76%), although there was no statistical significance. Excluding three live births without postnatal d-transposition of the great arteries, 65% (17/26) underwent arterial switch operation within 30 days. A total of three in-hospital deaths occurred and during the 10-month follow-up period, one death was observed. In one case, the switch procedure was performed at 13 months and the infant survived. Out of eight infants without arterial switch operation, two died.
Live birth rate increased after consultation; however, termination remained high. Combining termination, patients without arterial switch operation, and operative mortality, outcomes of d-transposition of the great arteries infants can be improved. Standard consultation, multidisciplinary collaboration, and improved perinatal care are important to improve outcomes.
本研究旨在探讨产前诊断为大动脉 d 转位胎儿的围产期及出生后早期结局，以及标准化产前咨询的影响。
2011 年至 2015 年在中国南方心脏中心前瞻性纳入所有产前诊断为大动脉 d 转位的胎儿。2013 年引入标准化产前咨询并实施综合措施，如设立胎儿先天性心脏病门诊咨询服务、按规范进行标准化产前咨询、组建由资深专家进行面对面咨询的多学科团队。进行持续随访调查。比较咨询前后的围产期及产后结局，包括活产、选择性终止妊娠、自然胎儿死亡、死产、转诊手术及存活情况。
共纳入 146 例胎儿，41 例（28%）失访。在其余 105 例胎儿中，29 例（28%）为活产，76 例（72%）被终止妊娠。咨询后，活产率较高（50%对 33%），终止妊娠率较低（50%对 76%），尽管无统计学意义。排除 3 例出生后无大动脉 d 转位的活产病例，65%（17/26）在 30 天内接受了动脉调转手术。共发生 3 例院内死亡，在 10 个月的随访期内，观察到 1 例死亡。1 例在 13 个月时进行了调转手术，婴儿存活。在 8 例未进行动脉调转手术的婴儿中，2 例死亡。
咨询后活产率有所提高；然而，终止妊娠率仍然较高。综合考虑终止妊娠、未进行动脉调转手术的患者及手术死亡率，大动脉 d 转位婴儿的结局可得到改善。标准化咨询、多学科协作及改善围产期护理对于改善结局很重要。
