Variation of Prenatal Detection of Congenital Heart Disease: An Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database

E. Ribeiro¹, J. Co-Vu¹, M. Quartermain², L. Bonnell³, D. Goldberg², L. Brinkley¹, S. Husain⁴, G. Peek¹, R. Habib⁵, J. St. Louis⁶, J. Nelson⁷, M. Bleiweis¹, M. Jacobs⁸, J. Jacobs^1
1University of Florida, Gainesville, Florida ²Children's Hospital of Philadelphia, Philadelphia, Pennsylvania ³The Society of Thoracic Surgeons, Philadelphia, Pennsylvania ⁴University of Utah School of Medicine, Salt Lake City, Utah ⁵The Society of Thoracic Surgeons, CHICAGO, Illinois ⁶Children's Hospital of Georgia, Augusta, Georgia ⁷Nemours Children's Hospital, Orlando, Florida ⁸Johns Hopkins School of Medicine, Newtown Square, Pennsylvania

Purpose: Prenatal congenital heart disease detection rates among patients requiring early surgical intervention have been low, with significant variability between states and across defect types. In 2013, obstetric screening ultrasound guidelines were updated, recommending addition of outflow tract views. We hypothesized that prenatal detection rates will have subsequently increased.

Methods: In the STS Congenital Heart Surgery Database (January 1, 2006 - June 30, 2023), patients aged < 6 months undergoing index procedures at US centers were identified. Excluded were non-cardiac procedures, isolated patent ductus arteriosus closures, or organ procurements. Additional exclusions were all patients at centers that were missing >15% of data for the prenatal diagnosis variables, and individual patients for whom the prenatal diagnosis field was missing or unknown. Further, patients with fundamental diagnoses that are difficult to ascertain by ultrasound imaging during fetal life were excluded (e.g. atrial septal defects, coronary artery anomalies, partial anomalous venous connection, vascular rings).

Prenatal detection rates were assessed overall, by year, and by lesion type, and were further stratified by whether or not the anomaly is one that is generally considered to be detectable on the 4-chamber view as opposed to those which require outflow tract views for detection and diagnosis.

Results: The relative proportion of cardiac operations performed in neonates and infants less than 6 months old in the United States that were associated with prenatal detection of the congenital cardiac disease has continuously increased from January 1, 2006 to June 30, 2023, as illustrated in Figure 1A.

As shown in Table 1, during the study timeframe the prenatal detection rate varied by lesion type, with detection rate as low as 13.1% (629/4791) for total anomalous pulmonary venous connection, and as high as 77.1% (7803/10127) for hypoplastic left heart syndrome.

Subsequent to the updating of obstetric screening ultrasound guidelines recommending addition of outflow tracts views, the rate of prenatal diagnosis has increased for those lesions not routinely detected on a four-chamber view of the heart but visible on outflow tract views in comparison to those routinely detected on a four-chamber view of the heart (p=0.029 by Cochran Armitage Trend Test, Figure 1B).

Cases were further stratified by patient geographic region, with the highest rate in the Middle Atlantic at 56.2% (5891/10489), and the lowest in the West South Central at 43.6% (6668/15284).

Conclusion: Prenatal detection of congenital heart disease has increased over time. Detection rate for lesions not generally visualized on a 4-chamber view increased significantly relative to the prenatal detection rate of those that are detectable on the 4-chamber view. Investigation of the potential impact of increasing prenatal detection rates is warranted.

Identify the source of the funding for this research project: The data for this research were provided by The Society of Thoracic Surgeons’ National Database Access and Publications Research Program.