Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Korean Med Sci. 2019 Jun 24;34(24):e170. doi: 10.3346/jkms.2019.34.e170.
This study aimed to determine the effect of a multidisciplinary approach on the birth rate of fetuses with prenatally diagnosed congenital heart diseases (CHDs).
Among the fetuses of 724 gravidas who underwent fetal echocardiography in Samsung Medical Center from January 2013 to June 2017, 463 fetuses with normal cardiac structure, arrhythmia or simple left-to-right shunt were excluded, and the remaining 261 were included in the study. The subjects were subdivided into groups based on whether they were consulted multidisciplinarily, that is, consulted simultaneously by pediatric cardiologists, obstetricians and pediatric cardiac surgeons or not. They were also categorized based on the initial fetal echocardiogram results.
Among the fetuses in the multidisciplinary group, 64.5% of the fetuses were given birth to, and the proportion was not different from that in the non-multidisciplinary group (68.6%, = 0.48). The delivery rate in the multidisciplinary consultation group were 69.2% in the transposition of the great arteries group, 63.6% in the tetralogy of Fallot group, 68.8% in the pulmonary atresia or interrupted aortic arch group, 62.5% in the coarctation of aorta group, 60.0% in the atrioventricular septal defect group, 70.0% in the functional single ventricle group, and 55.6% in the hypoplastic left heart syndrome group; there were no significant differences between the 10 echocardiogram groups. However, when the subjects were categorized into Fontan repair group and biventricular repair group, the Fontan repair group showed a significant increase in the likelihood of delivery when a multidisciplinary approach was taken ( = 0.035).
When a fetus was diagnosed with a CHD where Fontan repair should be considered, a multidisciplinary approach resulted in increased possibility of delivery.
本研究旨在探讨多学科方法对经产前超声心动图诊断的先天性心脏病（CHD）胎儿出生率的影响。
在 2013 年 1 月至 2017 年 6 月期间于三星医疗中心接受胎儿超声心动图检查的 724 名孕妇的胎儿中，排除了心脏结构正常、心律失常或单纯左向右分流的 463 名胎儿，剩余 261 名胎儿纳入本研究。根据是否多学科会诊，将研究对象分为多学科会诊组和非多学科会诊组；同时根据初始胎儿超声心动图结果进行分组。
多学科会诊组的胎儿中有 64.5%分娩，与非多学科会诊组的比例（68.6%，=0.48）无差异。大动脉转位组、法洛四联症组、肺动脉闭锁或主动脉弓中断组、主动脉缩窄组、房室间隔缺损组、功能性单心室组和左心发育不良综合征组的多学科会诊组分娩率分别为 69.2%、63.6%、68.8%、62.5%、60.0%、70.0%和 55.6%，10 个超声心动图组之间无显著差异。然而，当将研究对象分为 Fontan 修复组和双心室修复组时，多学科方法组 Fontan 修复组的分娩可能性显著增加（=0.035）。
当胎儿被诊断为需要进行 Fontan 修复的 CHD 时，多学科方法可提高分娩的可能性。
