C. Stephens1, N. Hamilton1 1Oregon Health And Science University,Pediatric Surgery,Portland, OR, USA
Introduction:
Duodenal atresia is associated with congenital cardiac anomalies that may complicate the delivery of anesthesia during duodenal atresia repair and the perioperative hospital course. As a result, neonatal echocardiograms (ECHOs) are often obtained prior to any surgical intervention for correction of duodenal atresia. However, most infants currently undergo high-resolution anatomic screening fetal ultrasounds, at which time most cardiac anomalies are identified. No studies have examined the utility of obtaining neonatal ECHOs in asymptomatic patients with duodenal atresia prior to surgical repair.
Methods:
We conducted an IRB-approved retrospective chart review of all patients with duodenal atresia treated at two tertiary care children’s hospitals between January 2005 and February 2016. Demographic information and patient comorbidities were analyzed. Prenatal ultrasounds were reviewed and compared to neonatal ECHOs to find any missed cardiac anomalies. Surgical timing and outcomes were examined. Statistical analysis was performed using Chi square analysis and student t-tests.
Results:
We identified 61 infants with duodenal atresia, 47% of whom were female, and 28% of whom had trisomy 21. The fetal ultrasound records were found for 58 (95%) patients. Forty-one (65%) were diagnosed with duodenal atresia by fetal ultrasound. Sixteen patients underwent fetal ECHO and 10 (16%) were found to have cardiac anomalies. Fifty-two patients (85%) underwent neonatal ECHO, including 6 patients who had normal fetal ECHO. Cardiac lesions were identified in 9 patients, including 4 patients with trisomy 21 (one Tetralogy of Fallot, 2 atrioventricular canals and one ventricular-septal defect), all diagnosed prenatally (p<0.001). One cardiac lesion (ventricular-septal defect) identified on fetal ECHO was no longer present. Only one patient required a delay in repair of duodenal atresia due to the cardiac anomaly which resulted in hemodynamic instability. All other patients, both with and without cardiac lesions, underwent repair of duodenal atresia without intraoperative cardiac events.
Conclusion:
In patients with duodenal atresia in whom no cardiac lesions are identified prenatally, it is unlikely that any new clinically significant cardiac lesions will be found on further cardiac imaging and neonatal ECHO can be avoided. In duodenal atresia patients with cardiac lesions identified on fetal imaging but who are asymptomatic, the addition of neonatal ECHOs result in no changes to clinical management and the imaging should not delay surgical care of duodenal atresia.