Foetal Outcomes after HLHS Diagnosis: A 10 year Queensland Experience

Abstract

Introduction: With the advances in foetal echocardiography over the last 20 years, the majority of hypoplastic left heart syndrome (HLHS) is now diagnosed antenatally. In this retrospective study, we looked at outcomes after antenatal diagnosis of HLHS in our centre. Methods: We reviewed the reports of all the foetal echocardiograms done between 2008 and 2017 and selected all the patients with a diagnosis of HLHS. Information on the mother and pregnancy were obtained from the obstetric notes. Results: There was a total of 160 foetuses with a diagnosis of HLHS in our study period. Foetal echocardiograms were performed at an average gestational age of 21 + 5 weeks (+/−4+1 week). There was one intrauterine death before a parental decision was made. Parents elected to terminate in 85 cases (53.1%), chose compassionate/palliative care in 26 pregnancies (16.3%) and elected for surgery in 48 cases (30%). There was no significant difference in outcomes between the two foetal cardiologists (p = 0.45). Prior to 2015, when patients had to travel interstate for the Norwood palliative surgery, out of 110 pregnancies with HLHS, only 27 parents (24.5%) elected for surgery. From 2015, this percentage significantly increased to 42% (21 out of 50 cases) which was statistically significant (p = 0.02) Conclusions: Our study demonstrates the outcomes after foetal diagnosis of HLHS with the availability of local Norwood surgery significantly impacting on parents’ decision to proceed with surgical intervention.L20022347162019-08-01 <br />