Prenatal and postnatal determinants of clinical outcomes in congenital heart diseases: A 15-year retrospective cohort study

OBJECTIVE: Congenital heart diseases (CHDs), the most common congenital anomalies, significantly impact pediatric morbidity and mortality. This 15-year retrospective study investigates prenatal features and postnatal outcomes in CHD cases, focusing on factors influencing surgical intervention, mortality, and long-term care. MATERIALS AND METHODS: We retrospectively reviewed 170 perinatally diagnosed CHD cases at Taichung Veterans General Hospital between January 2008 and October 2023. Diagnosis was primarily based on two-dimensional grayscale and Doppler echocardiography, with speckle tracking echocardiography (STE) employed in several cases. Among these, 119 ongoing pregnancies continued to delivery, 32 ended in termination of pregnancy (TOP) or intrauterine fetal demise (IUFD), and 19 were lost to follow-up. CHDs were categorized using two classification systems based on anatomical, physiological, and locational criteria. Maternal and fetal characteristics and echocardiographic findings were analyzed. RESULTS: Prenatal diagnosis was achieved in 93.5 % of cases, with a median gestational age of 22 weeks at diagnosis. Genetic abnormalities were detected in 3.4 % of cases for karyotypes and 9.3 % for gene dosage changes. CHD subtype distributions varied significantly among outcome groups. In classification-1, left-to-right shunts and arrhythmias predominated in the delivery group, cyanotic CHDs were most common in the TOP/IUFD group, and obstructive lesions/miscellaneous conditions were more frequent in the lost to follow-up group (P = 0.012). In classification-2, right- and left-sided disorders were most frequent in the delivery group, while mixed or unclassified disorders dominated the TOP/IUFD group (P = 0.003). Isolated CHDs accounted for 71.2 % of cases but were significantly less frequent in the TOP/IUFD group (P = 0.001). A higher number of coexistent intracardiac anomalies increased the risk of TOP/IUFD (P < 0.001). Significant group differences were also noted for isolated ventricular septal defect (P = 0.009) and right aortic arch (P = 0.003). Among the 119 deliveries, 24.4 % required early postnatal interventions. Predictive factors included cyanotic CHDs, obstructive lesions, and arrhythmias (P < 0.001). Neonatal mortality was strongly associated with a 5-min Apgar score <7 (adjusted odds ratio [aOR] 6.63, P = 0.037). Coexistent intracardiac anomalies increased the risk of hospital readmission (aOR 1.71, P = 0.034) and post-neonatal surgery (adjusted hazard ratio [aHR] 1.63, P < 0.001). Both STE and conventional echocardiography provided important insights into myocardial function and hemodynamics in severe cases. CONCLUSION: CHD type, complexity, and coexisting conditions, along with key prenatal and postnatal factors, significantly influence outcomes including mortality, surgical needs, and readmission risk. Prospective studies incorporating functional cardiac assessment are warranted to further improve CHD management.