Event Title

PRENATAL DIAGNOSIS OF COMPLEX CONGENITAL HEART DISEASE IN KOSOVO AS A COUNTRY WITH LIMITED RESOURCES IMPROVE SURVIVAL

Session

Medicine and Nursing

Description

Congenital heart diseases (CHD) are not common congenital abnormalities in the human foetus, but their serious consequences and high rate of mortality make early detection and treatment essential. Several risk factors for CHD, including maternal and fetal factors, have been reported. Improving fetal echocardiography as a screening at primary level and as definitive diagnosis at tertiary level has been shown the best diagnostic approach to identify the majority of complex structural cardiac abnormalities. In order to improve the prenatal detection of CHD, a screening test, which can be offered to all pregnancies, is required. Kosovo, as youngest country in Europe, with high natality and high neonatal mortality rate, mostly caused from CHD, with completely absent paediatrics cardio surgery service, it should begin to apply prenatal screening and transport in utero as a better solution in the treatment of neonates with complex CHD.

Aim of presentation: our aim was to establish whether local improvement in prenatal diagnosis of complex CHD, improved early survival rate comparing pregnancies completed in Kosovo with those transported in utero at the center where early cardiac surgery intervention can be done. All neonates diagnosed postnataly have been excluded from the study.

Methods: Retrospectively we analysed medical records of 28 pregnant women diagnosed with foetuses with complex CHD, divided in two groups: those where the birth was completed in Kosovo (group 1) and those where the birth was completed abroad after in-utero transport (group 2). Group 1 included 18 pregnant (64%); of them 8 have been with single ventricle (4 with hypoplastic left heart syndrome –HLHS, 3 with tricuspid atresia – TA, and one with pulmonary atresia and ventricular septal defect – PAVSD), 6 with TGA, 3 with PA without VSD and 1 with complete AV canal and tetralogy of Fallot (AVCTOF). Group 2 included 10 pregnant (36%); of them four with TGA, three with HLHS and three with TA. In both groups prenatal diagnosis was done between 16 and 32 weeks of gestations (average 24 weeks and 4 days). In all neonates soon after delivery transthoracic echocardiography was done and in all of them basic prenatal diagnosis is confirmed. From group 1 two neonates with HLHS, in the absence of prostaglandins and two with D-TGA in absence of Rashkind balloon have died soon after birth (22%). In 4 neonates balloon atrioseptostomy procedure successfully was done. All other neonates have been treated with prostaglandins and transport abroad Kosovo, using normal air flight lines, was done. All have survived the first palliative intervention. All neonates from group two have survived palliative interventions necessary for the relevant pathology.

Conclusion: Prenatal echocardiography in Kosovo is shown completely as a sensitive procedure in diagnosing complex CHD. In a country with limited resources transport in utero is the best solution in the immediate postnatal treatment, including medical treatment with Prostaglandins, balloon atriospetostomy procedure and cardiosurgery interventions.

Keywords:

prenatal echocardiography, complex congenital heart disease, in-utero transport, prostaglandins

Proceedings Editor

Edmond Hajrizi

ISBN

978-9951-550-47-5

Location

UBT Kampus, Lipjan

Start Date

30-10-2021 12:00 AM

End Date

30-10-2021 12:00 AM

DOI

10.33107/ubt-ic.2021.200

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Oct 30th, 12:00 AM Oct 30th, 12:00 AM

PRENATAL DIAGNOSIS OF COMPLEX CONGENITAL HEART DISEASE IN KOSOVO AS A COUNTRY WITH LIMITED RESOURCES IMPROVE SURVIVAL

UBT Kampus, Lipjan

Congenital heart diseases (CHD) are not common congenital abnormalities in the human foetus, but their serious consequences and high rate of mortality make early detection and treatment essential. Several risk factors for CHD, including maternal and fetal factors, have been reported. Improving fetal echocardiography as a screening at primary level and as definitive diagnosis at tertiary level has been shown the best diagnostic approach to identify the majority of complex structural cardiac abnormalities. In order to improve the prenatal detection of CHD, a screening test, which can be offered to all pregnancies, is required. Kosovo, as youngest country in Europe, with high natality and high neonatal mortality rate, mostly caused from CHD, with completely absent paediatrics cardio surgery service, it should begin to apply prenatal screening and transport in utero as a better solution in the treatment of neonates with complex CHD.

Aim of presentation: our aim was to establish whether local improvement in prenatal diagnosis of complex CHD, improved early survival rate comparing pregnancies completed in Kosovo with those transported in utero at the center where early cardiac surgery intervention can be done. All neonates diagnosed postnataly have been excluded from the study.

Methods: Retrospectively we analysed medical records of 28 pregnant women diagnosed with foetuses with complex CHD, divided in two groups: those where the birth was completed in Kosovo (group 1) and those where the birth was completed abroad after in-utero transport (group 2). Group 1 included 18 pregnant (64%); of them 8 have been with single ventricle (4 with hypoplastic left heart syndrome –HLHS, 3 with tricuspid atresia – TA, and one with pulmonary atresia and ventricular septal defect – PAVSD), 6 with TGA, 3 with PA without VSD and 1 with complete AV canal and tetralogy of Fallot (AVCTOF). Group 2 included 10 pregnant (36%); of them four with TGA, three with HLHS and three with TA. In both groups prenatal diagnosis was done between 16 and 32 weeks of gestations (average 24 weeks and 4 days). In all neonates soon after delivery transthoracic echocardiography was done and in all of them basic prenatal diagnosis is confirmed. From group 1 two neonates with HLHS, in the absence of prostaglandins and two with D-TGA in absence of Rashkind balloon have died soon after birth (22%). In 4 neonates balloon atrioseptostomy procedure successfully was done. All other neonates have been treated with prostaglandins and transport abroad Kosovo, using normal air flight lines, was done. All have survived the first palliative intervention. All neonates from group two have survived palliative interventions necessary for the relevant pathology.

Conclusion: Prenatal echocardiography in Kosovo is shown completely as a sensitive procedure in diagnosing complex CHD. In a country with limited resources transport in utero is the best solution in the immediate postnatal treatment, including medical treatment with Prostaglandins, balloon atriospetostomy procedure and cardiosurgery interventions.