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Impact of prenatal diagnosis of coarctation on short- and long-term cardiovascular outcome
Session:
Posters - F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Speaker:
Miguel Fogaça Da Mata
Congress:
CPC 2021
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
20. Congenital Heart Disease and Pediatric Cardiology
Subtheme:
20.7 Pediatric Cardiology
Session Type:
Posters
FP Number:
---
Authors:
Miguel Fogaça Da Mata; Mariana Lemos; Marta Martins; Tchitchamene Nelumba; Susana Cordeiro; João Rato; Ana Teixeira; Graça Nogueira; Isabel Menezes; Rui Anjos
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Introduction: Prenatal diagnosis of congenital heart disease has become increasingly more frequent. We investigated the cardiovascular impact of prenatal diagnosis on pre-operative course and short-, mid-, and long-term follow up of surgically corrected neonatal coarctation.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: We retrospectively reviewed 102 patients with isolated neonatal coarctation corrected surgically in our center between 1999 and 2019 with more than one year follow up and who maintained regular follow-up by our group. Cases of coarctation associated with any other significant heart disease were excluded. We collected data regarding presence of prenatal diagnosis, complicated pre-operative course (shock, need for ventilatory or inotropic support, multiorgan failure), prostaglandin infusion, age at surgery, post-operative complications, presence of acute renal injury, days at ICU, hospital stay, residual coarctation, persistent hypertension requiring medication at 1 and 6 months post-operative. Long term follow-up data included persistent hypertension, indexed left ventricular mass and need for reintervention were collected. A long-term negative composite outcome of persistent hypertension or Left Ventricular hypertrophy or need for reintervention was evaluated. Statistical analysis was performed with R v3.5.3. For binomial variables chi-squared tests were used, for continuous variables we used logistic regression tests.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: We identified 102 cases of simple neonatal coarctation. Of these 33 (32.3%) had prenatal diagnosis. In cases with prenatal diagnosis, there was a statistically significant lower incidence of complicated neonatal course (3,0% vs 30,4%; p<0,01), and lower incidence of shock, multiorgan failure or need for ventilatory support (table1). Age at surgery was significantly lower in the prenatal diagnosis group (5,1 days vs 14,9 days, p < 0.001). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">At mid- and long-term follow up, there were no significant differences between the groups with or without prenatal diagnosis, on rates of late reintervention, hypertension, or prevalence of LV hypertrophy (table1), p = NS. Similar findings were seen for presence of neonatal complicated course, which did not influence the occurrence of any of the aforementioned late complications. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusion: Despite playing a significant role in minimizing the severity of the neonatal presentation, prenatal diagnosis of coarctation or a less severe neonatal course did not influence mid- and long-term cardiovascular outcomes of neonates with coarctation.</span></span></p>
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