Moving Towards Universal Prenatal Detection of Critical Congenital Heart Disease in Southern Nevada: A Community-Wide Program

Abstract

This study compares the current, prenatal detection rate for critical congenital heart disease in Southern Nevada with the previously reported rate, after developing and expanding a comprehensive, community-wide fetal cardiology program. For the current-period analysis, we inquired our database and electronic health records for patients born in Clark County, Nevada, with critical congenital heart disease between May 2012 and April 2014, and we compared the results with the previous period between May 2003 and April 2006. The major components of the community-wide program include fetal congenital heart disease screening via general obstetric ultrasound studies performed in obstetrician's offices, radiology imaging centers, or maternal-fetal medicine specialty practices; subsequent referral for comprehensive fetal echocardiography performed in maternal-fetal medicine offices under the on-site supervision by fetal cardiologists; and recurring community educational programs teaching the 5-axial plane, fetal echocardiographic screening protocol to general obstetric sonographers and instructing perinatal sonographers in advanced imaging topics. For the current period, the prenatal detection rate for critical congenital heart disease in Southern Nevada was 71 versus 36% for the previous period (p < 0.001). The temporal improvement in prenatal detection of critical congenital heart disease may be related to our expanded decentralized, community-wide fetal cardiology program, and our experiences may be applicable to other metropolitan areas.

Right aortic arch with situs solitus

“…During this period, our prenatal detection rate for a RAA was 85%. We previously reported the results of how our regionalized fetal cardiology program, which over time has improved the detection of significant congenital heart disease . Briefly, our approach consists of ongoing community‐wide educational programs for general obstetric and specialized perinatal sonographers.…”

“…Right aortic arch, VR, presence and position or absence of the ductus arteriosus were all identified by either fetal echocardiography, neonatal echocardiography if the ductus arteriosus were patent, computed tomography, magnetic resonance imaging, or cardiac catheterization and angiography. We undertook fetal cardiovascular evaluations, as we previously reported . We defined a prenatal detection rate as the number of patients detected prenatally divided by the total number of patients identified that were born during the evaluation period.…”

Disparities in the prenatal detection of critical congenital heart disease

“…Our data suggest that training programs in detection of CHD by screening obstetric ultrasound should be targeted to these impoverished, rural communities for the greatest impact. Supervision of imaging and specialized training on normal findings for more complex views has been demonstrated to be effective by Evans et al and could be a focus for continuing education …”

Right aortic arch with situs solitus frequently heralds a vascular ring

“…Despite previous reports, we do not consider a left aortic arch with an aberrant right subclavian artery a vascular ring or a “partial” vascular ring, and no such patients were included in this analysis. We undertook fetal cardiovascular evaluations as previously reported . We defined a prenatal detection rate as the number of patients detected prenatally divided by the total number of patients identified that were born during the study period.…”