0491: Extracardiac or chromosomal anomalies strongly influence parental treatment decision and postnatal survival of neonates with prenatally diagnosed congenital heart diseases

ObjectivesThis study was design to assess the influence of extracardiac or chromosomal anomalies on parental decision of termination of pregnancy and on survival rates in newborns with prenatally diagnosed congenital heart diseases.Methods and results2057 consecutive foetuses with congenital heart disease diagnosed from January 2002 to December 2011 were included: 1258 (61%) in-born neonates and 799 (39%) terminations of pregnancy (TOP). The overall prevalence of major extracardiac or chromosomal anomalies was 18,6%. Of the 1258 newborns, 121 had a major associated anomaly but only 55 were identified before birth. Prenatally identified associated anomalies were significantly lower in the newborn group in comparison with the TOP group (4% vs 31%, p<0,0001). They were also lower in the surviving group at one year of follow up (7,5% vs 20,7%, p<0,0001). A 4-fold increase of death rate was observed if an associated anomaly was identified (IC95%[2,5-6,7], p<0,0001). These associations remained significant after multiple logistic regression analysis including the severity of the heart defect (univentricular or biventricular physiology).ConclusionWomen are more likely to terminate pregnancy if extracardiac or chromosomal anomalies are associated. Post natal survival is strongly influenced by these associated anomalies

0228: Impact of the precision of prenatal diagnostic of congenital heart diseases on perinatal and long-term management

ObjectiveTo evaluate the impact of precising prenatal diagnosis of congenital heart diseases (CHD) on perinatal and long-term management.MethodsOver a 10-year period, 1258 neonates with a prenatally diagnosed CHD and 189 fetal autopsies after termination of pregnancy were included. Changes in CHD diagnosis were classified as totally different, similar but leading to changes in neonatal management, and similar without changes on initial management. The impact on long-term outcome was considered negative if the final diagnosis was a more complex CHD precluding the planned biventricular repair, or if additional surgical interventions were needed, or if the complexity level of the Aristotle score was increased. The impact on outcome was considered positive if biventricular repair was possible while not planned prenatally, or if the number of surgical interventions was reduced, or if the complexity level of the Aristotle score was lower.ResultsThe post-natal diagnosis was imprecise in 30.2% of the cases: completely different in 2.9%, led to changes in initial management in 8%, and did not affect initial management in 19.3%. Imprecision in the prenatal diagnosis had a negative impact on long-term outcome in 4.9% of the cases, and a positive impact in 4.1%.In the fetal autopsy group (mean term 26 weeks), the diagnosis was imprecise in 54.5% of the cases: completely different in 8.5%, could have led to changes in postnatal management in 14.3%, and with minor differences that would not have led to changes in management in 31.7%. In both groups, the most frequent differences were anomalies of the outflow tract anatomy (43%), and the systemic or pulmonary veins (25%).ConclusionImprecision of prenatal diagnosis of CHD changes early management in 11% of the cases, and impacts long-term outcome in 9% of the cases. Improvement of CHD diagnosis for anatomy of the outflow tract and main veins should help to reduce impact on postnatal management and outcome