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Factors affecting prognosis for survival in atrioventricular septal defect diagnosed in fetal life

Huggon, IC; Cook, AC; Sharland, GK; (1999) Factors affecting prognosis for survival in atrioventricular septal defect diagnosed in fetal life. Heart , 81 (SUPPL. 1)

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Abstract

301 fetuses with a final diagnosis of atrioventricular septal defect (AVSD) were identified from records of 14,726 pregnancies in which fetal echocardiography was performed over an 11-year period. Associated anatomical features, extra-cardiac abnormalities date of diagnosis and outcome were established. Kaplan-Meier analysis, the logrank test and Cox's proportional hazards model were applied to compare the outcome of continuing pregnancies according to these factors. Parents elected to terminate 175 pregnancies (59%). Chromosome abnormality, complex cardiac anatomy and extra-cardiac abnormality were not significantly commoner in this group than in those continuing, but there was a significant decrease over time in the proportion terminating their pregnancy. For those intending to continue, Kaplan-Meier estimates were 82% for live-birth, 55.2% for 1-month and 37.8% for 3-year survival. A negative relationship to survival was shown for ventricular dominance, absence of pulmonary obstruction, extra-cardiac abnormalities, fetal bradycardia and hydrops, but was significant only for the latter two. Survival was unrelated to the presence of isomerism, chromosome abnormality or anteriorly positioned aorta. On multivariate analysis, the only independent variables adversely affecting survival were fetal hydrops and earlier year of diagnosis. Three-year survival in a sub-group with isolated heart defects and uncomplicated anatomy was only 55.4%. Associated cardiac and extra-cardiac abnormalities may identify fetuses with AVSD who have particularly poor outlook, but despite some improvements over time, the prognosis for survival is poor even in the absence of such features.

Type: Article
Title: Factors affecting prognosis for survival in atrioventricular septal defect diagnosed in fetal life
UCL classification: UCL > Office of the President and Provost
UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
URI: http://discovery.ucl.ac.uk/id/eprint/1306902
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