Anita Krishnan

BACKGROUND: Hypoplastic left heart syndrome (HLHS) is classified by anatomic subtype: mitral atresia and aortic atresia (MA/AA), mitral stenosis and aortic atresia (MS/AA), and mitral stenosis and aortic stenosis (MS/AS). The MS/AA subtype is associated with ventriculocoronary connections (VCCs). We assessed whether specific HLHS subtypes are associated with an increased risk of mortality and whether this risk is stratified by VCCs identified during fetal or postnatal echocardiography. We also assessed whether the type of neonatal intervention performed modified the risk. METHODS: We performed a multicenter retrospective cohort study of fetuses and infants P =0.784). CONCLUSIONS: In a large, multicenter cohort of HLHS patients, the MS/AA subtype with VCCs had the lowest TFS. Prenatal diagnosis of VCCs was associated with a lower TFS. This study underscores the prognostic value of assessing for VCCs in patients with HLHS both before and after birth.

Congenital heart disease is the most common birth defect worldwide. Perinatal detection, either in utero or prior to hospital discharge is important for planning delivery, ordering adjunct testing, and planning for surgical or medical care. In countries with access to ultrasound screening, prenatal detection is highly accurate though with variable sensitivity and specificity around the world. Pulse oximetry screening, in some cases coupled with murmur auscultation in the nursery can also reach very high degrees of sensitivity for critical congenital heart disease. Use of the modalities per guidelines and recommendations is an important aspect of decreasing infant mortality and morbidity worldwide.

Introduction: Emerging evidence suggests that an impaired foetal environment—defined as maternal factors such as hypertensive disorders and diabetes—might contribute to outcomes in neonates with CHD. With this multicentre study, we prospectively collected data regarding impaired foetal environment to assess the impact on mortality in two ventricle and single ventricle neonates with CHD. Materials and methods: A module of prospectively collected maternal-foetal environment data was linked to established Pediatric Cardiac Critical Care Consortium data from June 2019 to July 2020. All neonates undergoing cardiothoracic surgery were included in this study. The outcome was in-hospital mortality. The primary predictor was the degree of impaired foetal environment defined as none, mild, or significant based on the presence of maternal hypertensive and glucose homeostasis disorders. Results: There were a total of 1913 neonates included in this study from 26 different centres. 218 patients had at least 1 missing impaired foetal environment data field (11.8%). Impaired foetal environment was not associated with increased mortality; however, there was a strong trend in the preterm single ventricular population. Discussion: While the overall cohort did not demonstrate a statistically significant relationship between impaired foetal environment and mortality, a notable trend emerged among preterm infants with single-ventricle physiology, suggesting increased mortality associated with more severe impaired foetal environment. The absence of statistical significance in this subgroup is likely attributable to the limited sample size and the substantial proportion of missing data highlighting the challenges of the mother-baby dyad in data collections.

Introduction: There is a critical clinical need for fetal electrocardiography (fECG), but no methods have successfully translated to the ambulatory setting. We developed a novel fECG system combining custom hardware and null coherence-based signal processing, then evaluated its feasibility for fECG extraction in normal and at-risk pregnancies. Methods: We applied the fECG system to 43 patients (25 normal fetuses, 18 abnormal). FECG studies were 15 min long and utilized 12–24 electrodes and 1 ground. Signal processing was done during collection with additional post-processing. Two clinician raters blinded to gestational age, indication, and each other’s assessments, graded the quality of studies using a 5-point scale. The raters measured the PR, QRS, and/or QTc intervals twice where possible. Results: In 43 subjects, 30 had time-resolved fECG separation (70%) and the median grading (based on two raters across two sessions) was 3 or greater in 26/43 fetuses (60%) with graded studies. Sixty three percent of cases (27/43) had a measurable fetal cardiac time interval. Signal quality was reduced in participants with BMI ≥30 and during the vernix period (25–32 weeks’ gestation). Conclusion: Our findings demonstrate the feasibility of fECG across gestation, enabling beat-to-beat signal extraction and CTI measurement with a 63% success rate.

Etiologies of congenital heart disease (CHD) are multifactorial. The role of maternal nutrition and environmental factors among these CHD etiologies remain insufficiently understood. This pilot study evaluated the potential association between maternal diet quality, nutrient intake, and food security to fetal CHD in a cohort of 100 pregnant individuals, including 20 with CHD-affected pregnancies identified in a fetal cardiology clinic at an urban tertiary care hospital. A Diet Quality Photo Navigation (DQPN) tool assessed dietary quality and nutrient intake, while a survey collected data on demographics, health history, and food security. Comparison tests assessed for differences between CHD- and non-CHD-affected pregnancies. CHD-affected pregnancies demonstrated descriptively lower Healthy Eating Index scores, reduced prenatal multivitamin use, and lower intake of iron, manganese, fiber, and vitamin C. The non-CHD group demonstrated a significantly higher consumption of healthier snacks (p = 0.03), plant-based meat alternatives (p = 0.05), and unsweetened beverages (p = 0.05), while descriptively showing greater fruit and vegetable intake as compared to the CHD-affected group. No statistically significant differences in food security or socioeconomic indicators were identified. These findings demonstrate the feasibility of applying a DQPN tool in fetal health research and describe maternal dietary patterns that may inform the design of future hypothesis-driven studies. Continued investigation into maternal diet quality is critical to understand its potential role in mitigating CHD risk through targeted nutritional interventions.

BACKGROUND: 2D-speckle tracking echocardiography may help detect subclinical ventricular dysfunction, but data in multisystem inflammatory syndrome in children (MIS-C) are scarce. We investigated left ventricular (LV) strain parameters in MIS-C and their association with outcomes. METHODS: We performed an ambi-directional, 32-center cohort study on hospitalized MIS-C patients (March 2020–November 2021) with at least 1 echocardiogram read by the Core Lab. Generalized estimating equation modeling was used to test associations between LV strain and a composite in-hospital adverse cardiovascular outcome (vasoactive support, arrhythmias, cardiac arrest, extracorporeal support, death, or heart transplant). RESULTS: Of 349 patients (median age, 8.7 years [interquartile range, 5.3–12.9]), 35% had decreased LV ejection fraction during hospitalization, and 45% had depressed LV strain (either 4-chamber LV longitudinal strain [4CH-LVLS] or mid-ventricular LV circumferential strain [mid-LVCS]). The worst 4CH-LVLS and mid-LVCS occurred at ≈5 days of illness; 50% of abnormal LV strain normalized within 1 week, and 95% within 50 days. In-hospital adverse outcomes occurred in 35% of patients; these patients were older ( P =0.003) and, at admission, had more likely abnormal troponin ( P P P P =0.015), worse LV ejection fraction ( P P =0.002; mid-LVCS, P =0.001). Covariate-adjusted individual models for each strain parameter showed that 4CH-LVLS (adjusted odds ratio, 1.09 [95% CI, 1.07–1.12]), mid-LVCS (adjusted odds ratio, 1.06 [95% CI, 1.04–1.09]), worst LV strain Z score between 4CH-LVLS and mid-LVCS (adjusted odds ratio, 1.30 [95% CI, 1.21–1.41]), and early diastolic longitudinal strain rate (EDLSR; adjusted odds ratio, 1.68 [95% CI, 1.26–2.23]) at admission were found to be associated with adverse outcomes. CONCLUSIONS: About half of MIS-C patients had abnormal LV strain during hospitalization. 4CH-LVLS, mid-LVCS, the most abnormal strain Z score, and early diastolic longitudinal strain rate at admission were independently associated with in-hospital adverse cardiovascular outcome. These data may help early characterization and prognostication in MIS-C.

Background: Fetal echocardiography is the mainstay of prenatal diagnosis of congenital heart disease. The COVID‐19 pandemic led to shifts in triage of prenatal services. Our objective was to evaluate the impact of COVID‐19 restrictions on prenatal diagnosis, surgical outcomes, and disparities in neonatal critical congenital heart disease (CCHD) management in the United States during the pandemic's first year. Methods and Results: A multi‐institutional retrospective cohort study compared neonatal CCHD outcomes (requiring surgery within 60 days of birth) 1 year prior (prepandemic era) and during the peak pandemic era, supplemented by a Fetal Heart Society survey assessing regional practice changes. Data on prenatal diagnosis, demographics, outcomes, and 2020 state Area Deprivation Index were analyzed using Wilcoxon rank sum and χ ² tests. The survey, completed by 72 fetal cardiologists from 9 US census regions, showed 75% of institutions implemented restrictions by March 2020, affecting triage, referrals, and number of prenatal cardiology visits. Compared with CCHD neonates born prepandemic (n=4637), those born during the pandemic (n=1806) had a higher proportion of prenatal diagnosis (66% versus 63%, P <0.05). There were no significant differences in complications or mortality, but pandemic‐era neonates had longer hospital stays. During the pandemic, CCHD neonates had a more disadvantaged Area Deprivation Index and had surgery at hospitals located in more advantaged regions. Conclusions: Although pandemic‐driven care delivery adjustments affected perinatal cardiology referrals and triage, prenatal diagnosis, perioperative outcomes, and survival remained robust. The management of CCHD demonstrates health care resilience, maintaining core prenatal and perioperative care. Regional variations highlight the need for targeted strategies to address disparities during health care crises.

We develop a frequency domain template subtraction approach to attenuate the maternal ECG in the abdominal ECG measured from pregnant women. The proposed approach was tested on five public fetal ECG datasets simultaneously measured with ECG from the fetal scalp. The method’s performance was compared with the template subtraction approach in the time domain using the accuracy and association metrics. The accuracy was calculated by counting the number of fetal complexes in the processed data that coincided with the fetal complexes in the scalp fetal ECG. The association is quantified as the coherence between the processed data and the gold standard. The maximum coherence values calculated for each approach were compared using the paired t-test. Our results showed no difference in the accuracy between the frequency and time domain approach (p = 0.733). However, the association was higher between the frequency domain data and the gold standard compared to the template subtraction data and the gold standard (p = 0.049), indicating that the frequency domain approach yielded a signal that resembled that of the scalp ECG compared to the time domain approach.

Development of a national dataset for geospatial analysis of congenital heart disease