Objective To evaluate the clinical effectiveness of integrated management during the perinatal period for fetuses diagnosed with total anomalous pulmonary venous connection (TAPVC) by prenatal echocardiography. Methods Clinical data of 64 cases of TAPVC fetuses diagnosed by prenatal echocardiography and managed with integrated perinatal care in Qingdao Women and Children's Hospital from January 2017 to December 2021 were retrospectively analyzed. Integrated perinatal care included multidisciplinary collaboration among obstetrics, fetal medicine, ultrasound, pediatric cardiology, pediatric anesthesia, and neonatology. Results Among the 64 TAPVC fetuses, there were 29 cases of supracardiac type, 27 cases of intracardiac type, 2 cases of infracardiac type, and 6 cases of mixed type. Chromosomal analysis was performed in 42 cases, and no obvious abnormalities were found. Among the 64 TAPVC fetuses, 37 were induced labor, and 27 were followed up until term birth. Among the 27 TAPVC cases, 2 cases accepted palliative care, 2 cases were referred to another hospital for treatment and lost to follow-up, while the remaining 23 cases underwent primary repair surgery. One case died within 6 months after the operation due to low cardiac output syndrome, while the other 22 cases were followed up for (2.1±0.3) years with good outcomes (2 cases underwent a second surgery within 1 year after the first operation due to anastomotic stenosis or pulmonary vein stenosis). Conclusions TAPVC fetuses can achieve good outcomes with integrated management during the perinatal period.
Key words
Total anomalous pulmonary venous connection /
Congenital heart disease /
Perinatal period /
Integrated management /
Fetus /
Child
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
1 吴雨昊, 辛良靖, 金鑫, 等. Sutureless手术与传统手术治疗完全性肺静脉异位引流疗效的Meta分析[J]. 中华小儿外科杂志, 2019, 40(1): 15-22. DOI: 10.3760/cma.j.issn.0253-3006.2019.01.004.
2 Yoshimura N, Fukahara K, Yamashita A, et al. Current topics in surgery for isolated total anomalous pulmonary venous connection[J]. Surg Today, 2014, 44(12): 2221-2226. PMID: 24633930. DOI: 10.1007/s00595-014-0877-5.
3 罗晓芳, 漆洪波. 如何保证孕周的准确性[J]. 中华围产医学杂志, 2015, 18(5): 331-333. DOI: 10.3760/cma.j.issn.1007-9408.2015.05.002.
4 Shi X, Lu Y, Sun K. Research progress in pathogenesis of total anomalous pulmonary venous connection[J]. Methods Mol Biol, 2020, 2204: 173-178. PMID: 32710324. DOI: 10.1007/978-1-0716-0904-0_15.
5 王游声, 张亿聪, 张琪, 等. 胎儿颈项透明层增厚的产前诊断结果分析[J]. 中华医学遗传学杂志, 2022, 39(2): 248-250. DOI: 10.3760/cma.j.cn511374-20201029-00762.
6 Souka AP, von Kaisenberg CS, Hyett JA, et al. Increased nuchal translucency with normal karyotype[J]. Am J Obstet Gynecol, 2005, 192(4): 1005-1021. PMID: 15846173. DOI: 10.1016/j.ajog.2004.12.093.
7 Bilardo CM, Müller MA, Pajkrt E, et al. Increased nuchal translucency thickness and normal karyotype: time for parental reassurance[J]. Ultrasound Obstet Gynecol, 2007, 30(1): 11-18. PMID: 17559183. DOI: 10.1002/uog.4044.
8 Zhang X, Sun Y, Zhu J, et al. Epidemiology, prenatal diagnosis, and neonatal outcomes of congenital heart defects in eastern China: a hospital-based multicenter study[J]. BMC Pediatr, 2020, 20(1): 416. PMID: 32878605. PMCID: PMC7466801. DOI: 10.1186/s12887-020-02313-4.
9 Gupta N, Leven L, Stewart M, et al. Transport of infants with congenital heart disease: benefits of antenatal diagnosis[J]. Eur J Pediatr, 2014, 173(5): 655-660. PMID: 24326382. DOI: 10.1007/s00431-013-2231-0.
10 潘微. 胎儿先天性心脏病产前诊断与干预策略[J]. 岭南心血管病杂志, 2009, 15(4): 268-270. DOI: 10.3969/j.issn.1007-9688.2009.04.006.
11 曾秀梅, 梁元豪, 杜志成, 等. 胎儿先天性心脏病的早孕期超声筛查及产前诊断结果分析[J]. 中华围产医学杂志, 2018, 21(11): 737-744. DOI: 10.3760/cma.j.issn.1007-9408.2018.11.004.
12 张烨, 何怡华, 孙琳, 等. 常规胎儿超声心动图结合时间空间相关成像技术产前诊断完全性肺静脉异位引流[J]. 中华超声影像学杂志, 2015, 24(2): 118-122. DOI: 10.3760/cma.j.issn.1004-4477.2015.02.008.
13 Yang L, He X, Lu Y, et al. Integrated model for the prenatal diagnosis and postnatal surgical treatment of total anomalous pulmonary venous connection: a multidisciplinary collaborative experience and preliminary results[J]. J Card Surg, 2019, 34(11): 1264-1272. PMID: 31475761. DOI: 10.1111/jocs.14242.
14 Holland BJ, Myers JA, Woods CR. Prenatal diagnosis of critical congenital heart disease reduces risk of death from cardiovascular compromise prior to planned neonatal cardiac surgery: a meta-analysis[J]. Ultrasound Obstet Gynecol, 2015, 45(6): 631-638. PMID: 25904437. DOI: 10.1002/uog.14882.
15 Parikh LI, Grantz KL, Iqbal SN, et al. Neonatal outcomes in fetuses with cardiac anomalies and the impact of delivery route[J]. Am J Obstet Gynecol, 2017, 217(4): 469.e1-469.e12. PMID: 28578168. PMCID: PMC5793863. DOI: 10.1016/j.ajog.2017.05.049.
16 Shi G, Zhu Z, Chen J, et al. Total anomalous pulmonary venous connection: the current management strategies in a pediatric cohort of 768 patients[J]. Circulation, 2017, 135(1): 48-58. PMID: 27881562. DOI: 10.1161/CIRCULATIONAHA.116.023889.
17 Shaw FR, Chen JM. Surgical considerations in total anomalous pulmonary venous connection[J]. Semin Cardiothorac Vasc Anesth, 2017, 21(2): 132-137. PMID: 28107801. DOI: 10.1177/1089253216688535.
18 White BR, Ho DY, Faerber JA, et al. Repair of total anomalous pulmonary venous connection: risk factors for postoperative obstruction[J]. Ann Thorac Surg, 2019, 108(1): 122-129. PMID: 30885849. PMCID: PMC6591098. DOI: 10.1016/j.athoracsur.2019.02.017.
19 Seale AN, Uemura H, Webber SA, et al. Total anomalous pulmonary venous connection: outcome of postoperative pulmonary venous obstruction[J]. J Thorac Cardiovasc Surg, 2013, 145(5): 1255-1262. PMID: 22892140. DOI: 10.1016/j.jtcvs.2012.06.031.
PDF(512 KB)
