University of Louisville School of Medicine, Louisville, Kentucky, USA.
Department of Geography and Geosciences, University of Louisville, Louisville, Kentucky, USA.
Prenat Diagn. 2022 Aug;42(9):1120-1132. doi: 10.1002/pd.6196. Epub 2022 Jul 2.
To improve the rate of prenatal diagnosis of Congenital heart disease (CHD) in Kentucky, four fetal tele-echocardiography sites were established at regional hospitals in Kentucky: Ashland in 2011, Paducah in 2014, Lexington in 2014, and Owensboro in 2016.
A 13-year retrospective review of medical records at Norton Children's Hospital was performed to identify patients with CHD who had cardiac surgery or intervention prior to one year of age. The rate of prenatal diagnosis prior to establishing any fetal tele-echocardiography sites was compared to the rate of prenatal diagnosis after the sites were established. Independent t-tests were used to determine if there was a statistically significant increase in the rate of prenatal diagnosis.
1287 patients had cardiac surgery or cath lab intervention prior to one year of age at our institution from June 2005 to December 2018 and were included in the analysis. Seventeen patients were excluded due to incomplete medical records. The rate of prenatal diagnosis prior to the implementation of the first fetal tele-echocardiography site was 13.8% and after the sites were established, the prenatal diagnosis rate was 39.7% (p < 0.01).
Increasing the number of fetal tele-echocardiography sites at small regional hospitals in Kentucky was associated with a statistically significant increase in the rate of prenatal diagnosis for patients less than 1 year of age who had cardiac surgery or cath lab intervention at Norton Children's Hospital in Louisville. Fetal tele-echocardiography is an effective method to improve the rate of prenatal diagnosis in regions served by small regional hospitals with limited access to fetal echocardiography.
为提高肯塔基州先天性心脏病（CHD）产前诊断率，在肯塔基州的区域医院设立了四个胎儿远程超声心动图站点：阿什兰（2011 年）、帕迪尤卡（2014 年）、列克星敦（2014 年）和欧文斯伯勒（2016 年）。
对诺顿儿童医院的病历进行了为期 13 年的回顾性分析，以确定在一岁前接受心脏手术或介入治疗的 CHD 患者。在建立任何胎儿远程超声心动图站点之前，与建立站点后相比，产前诊断率。使用独立 t 检验确定产前诊断率是否有统计学意义的增加。
本机构 2005 年 6 月至 2018 年 12 月期间，有 1287 例患者在一岁前接受了心脏手术或心导管实验室介入治疗，并纳入分析。由于病历不完整，排除了 17 例患者。在第一个胎儿远程超声心动图站点实施前，产前诊断率为 13.8%，建立站点后，产前诊断率为 39.7%（p<0.01）。
在肯塔基州的小型区域性医院增加胎儿远程超声心动图站点的数量与在路易斯维尔的诺顿儿童医院接受心脏手术或心导管实验室介入治疗的年龄小于 1 岁的患者产前诊断率的统计学显著增加相关。胎儿远程超声心动图是提高由小型区域性医院服务的地区产前诊断率的有效方法，这些医院获得胎儿超声心动图的机会有限。
