Chen Gang,Guan Li,Chen Weicheng,et al.Preliminary management experience of integrated congenital heart disease diagnosis and treatment during perinatal period[J].Journal of Clinical Pediatric Surgery,,20():525-531.[doi:10.12260/lcxewkzz.2021.06.005]
Preliminary management experience of integrated congenital heart disease diagnosis and treatment during perinatal period
- Keywords:
- Heart Diseases/CN; Heart Defects; Congenital/SU; Heart Defects; Congenital/DI; Peripartum Period; Integrated Diagnosis and Treatment
- CLC:
- R541;R493.28;R541.92
- Abstract:
- Objective To explore the preliminary management experience of integrated congenital heart disease (CHD) diagnosis and treatment during perinatal period.Methods For this prospective cohort clinical trial,a total of 70,805 pregnant women were recruited from January 2018 to December 2019.Ever since early pregnancy registration,all participants received regularly antenatal examinations,delivery or termination of pregnancy.Their offspring was screened for congenital heart disease after delivery.Prenatal multidisciplinary counseling was provided for pregnant women with CHD fetuses.After delivery,pulse oximetry plus clinical evaluations were employed for CHD screening.Critical CHD was intervened during the neonatal period.Results Among them,41/70805,729/70433 and 22/70023 cases of cardiovascular malformation were detected in early,middle and late pregnancy respectively.And 318/792 cases underwent induced abortion,99.98% of neonates received postnatal CHD screening with a positive rate of 2.1%(1470/70023) and 95% of screening positive cases received echocardiography to make a definite diagnosis.Antenatal counseling was offered to 220 prenatal examination positive cases.And 164 cases had no induced abortion and it showed a higher rate of non-abortion compared with those without counseling (74.5% vs. 54.2%, χ2=27.38,P=0.000).Thirteen intrauterine fetuses and 37 neonates were transferred non-eventfully to qualified delivery facilities and cardiovascular centers.All 13 critical CHD neonates received emergency or sub-emergency operation,their weight range was 2.3 to 3.6 kg and operative age 16 hours to 4 days.The classification of operation was arterial switch (n=4),TAPVC correction (n=3),aorta arch reconstruction (n=1) and percutaneous balloon pulmonary valvuloplasty (n=5).And 25/37 neonates underwent sub-emergency operations of aortic arch reconstruction (n=13),percutaneous aortic balloon angioplasty (n=9) and percutaneous balloon pulmonary valvuloplasty (n=3).The hospitalization stay of 38 cases was (14-32) days.There was no operation-related mortality or severe complications.Conclusion Integrated perinatal management strategy is feasible and effective for CHD children.Prenatal screening and diagnostic process enhance the consistency of prenatal and postpartum diagnosis,reduce the incidence of severe birth defects and improve the prognosis of complex surgical repairs of CHD.
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Memo
收稿日期:2021-03-31;。
通讯作者:贾兵,jiabing2012@hotmail.com