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J Thorac Cardiovasc Surg 2001;121:798-803
© 2001 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Prenatal diagnosis of congenital heart disease affects preoperative acidosis in the newborn patient

From the Departments of Obstetrics, Pediatric Cardiology, and Thoracic Surgery, UMC,^a Utrecht, The Netherlands; the Department of Pediatric Cardiology, University of Maryland Medical System,^b Baltimore, Md; and the Departments of Obstetrics and Gynecology, and Pediatric Cardiology, Yale–New Haven Hospital, New Haven, Conn.^c

This study was supported by a grant from the VSB Bank Foundation, the Netherlands Heart Foundation, and the Schootemeijer-Niemans Foundation funded by the Prins Bernhard Foundation in The Netherlands.

Received for publication April 3, 2000. Revisions requested May 30, 2000; revisions received Oct 11, 2000. Accepted for publication Oct 20, 2000. Address for reprints: Ger B. W. E. Bennink, Department of Thoracic Surgery, University Medical Center (UMC), KG 01.3190/PO Box 85090, 3508 AB Utrecht, The Netherlands.

Abstract

Objectives: Congenital heart disease is the leading cause of death in the first year after birth. Prenatal diagnosis of the disease can optimize the preoperative condition of the patient and may help in the prevention of acidosis. In this retrospective study we compared the occurrence of metabolic acidosis in patients with and without prenatal diagnosis of a congenital heart disease.
Methods: Data of 408 patients who needed an operation for congenital heart disease within 31 days of life were analyzed retrospectively. Arterial blood gases at fixed time intervals and worst blood gas of 81 patients with and 327 patients without a prenatal diagnosis were compared, categorizing the patients on ductus dependency, anticipated univentricular or biventricular repair, and left-sided, right-sided, or no heart obstruction.
Results: In the overall group significant differences in lowest pH, lowest base excess, and highest lactate level were found, with metabolic acidosis more common among the patients with a postnatal diagnosis. In the group of patients with ductus-dependent congenital heart disease, the difference between patients receiving a prenatal and those receiving a postnatal diagnosis was more significant than in the group with non–ductus-dependent lesions. Analyzing patients with right-sided, left-sided, and no obstruction separately, significant differences were found in the group with left-sided heart obstruction for lowest pH and base excess and in the group with right-sided heart obstruction for lowest base excess.
Conclusions: Prenatal diagnosis of congenital heart disease minimizes metabolic acidosis in patients with congenital heart disease and may be associated with improved long-term outcome and prevention of cerebral damage among this fragile group of patients, although no significant effect on direct surgical outcome was encountered.

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