IN BRIEF

For Some Fetuses With HLHS, One Follow-up Echocardiogram May Be Enough

January 7, 2020
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Study suggests a low-risk subpopulation does not develop worsening heart conditions after initial test.

“Not every patient with hypoplastic left heart syndrome, also known as HLHS, is the same: there appears to be a high-risk group that has significant atrioventricular valve regurgitation, atrial septal restriction or other concerns; and a low-risk group that, on their first scan, has none of these comorbidities of the heart,” says Bernadette Richards, FASE, RDCS, lead sonographer in the Echocardiography Lab at The Heart Center at Nationwide Children’s.

“We found that the patients in the low-risk group didn’t develop high-risk issues throughout the rest of the pregnancy and they didn’t require any emergent interventions within the first 72 hours of life.”

Current guidelines recommend serial echocardiograms when congenital heart disease is diagnosed, but the frequency of scans is left up to the individual practitioner. In a study published in the International Journal of Cardiology, Richards and fellow researchers propose one follow-up fetal echocardiogram and follow-up family counseling for the low-risk group.

“These are critically ill patients with a very serious congenital heart problem, which is why close surveillance is preferred,” says Richards, lead author of the study. “But, there are benefits to not having multiple follow-up studies. There’s a financial benefit to the patient’s family and for some, the emotional benefit of not having to undergo additional testing.—

Further, she says, reducing the number of the expensive tests also serves the growing focus on health care equity, at a time when the impact of health care costs on the economy continues to grow.

The research team began looking into the serial images of patients in an effort to assess the variability in follow-ups among the cardiologists at The Heart Center. They wanted to see if high-risk concerns developed over time, providing good reason for frequent fetal echocardiograms, or if the data supported less-frequent testing in a low-risk population.

The team reviewed the records of all echocardiograms of fetuses with HLHS from 2006-2018. They focused on 48 babies who had no significant concerns beyond the underdeveloped left side of the heart. None developed significant heart comorbidities or underwent an emergent cardiac procedure within 72 hours following delivery.

“Within our group, we’ve seen some practice pattern changes,” Richards says. “Our group has been pretty accepting of these recommendations. However, if they think there’s a reason for patients to come back more frequently, we have them come back more frequently.”

Richards and her colleagues plan another study in the future, to follow the efficacy and impact of the recommended change.

 

Reference:

Richards B, Freel L, Stiver C, Texter K, Cua CL. Serial fetal echocardiograms in hypoplastic left heart syndrome fetuses: Does it affect immediate post-natal care? International Journal of Cardiology. 2019 Nov 21. pii: S0167-5273(19)33617-4.

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