P1.077: Assessing the Need for Postnatal Echocardiograms Prior to Congenital Duodenal Atresia Repair

Background: Congenital duodenal atresia (CDA) is an anomaly surgically repaired within the first few days of life; however, its association with congenital heart defects warrants preoperative evaluation of cardiac physiology. Given the prevalence of prenatal echocardiography, we sought to determine the value of a postnatal preoperative echocardiogram in patients who have undergone fetal echocardiography.

Methods: A retrospective chart review was performed on patients diagnosed with CDA at a tertiary children’s hospital from January 1, 2013 to December 31, 2023. Patients with incomplete records and those who did not undergo echocardiography were excluded. Echocardiogram findings were reviewed, and defects were divided into categories based on the primary physiology – shunting e.g. atrioventricular canal, conotruncal anomalies e.g. tetralogy of Fallot, single ventricle physiology e.g. hypoplastic left heart, complete mixing e.g. transposition of the great arteries, and other anomalies that did not fit these defined categories. Persistent ductus arteriosus and atrial septal defects seen postnatally were considered normal variants of newborn anatomy.

Results: Of the 90 patients with CDA meeting inclusion criteria, 38 (42%) had an associated syndrome – 32 (36 %) had chromosomal abnormalities and 6 (7%) had VACTERL association. Nineteen (50%) patients with syndromic abnormalities and 11 (21%) patients without syndromic abnormalities had cardiac anomalies (Figure 1). Twenty (22%) patients had shunting disorders, 7 (8%) had conotruncal anomalies, and 1 (1%) patient had single ventricle physiology, but no patient with complete mixing physiology was identified. There were 2 (2%) patients who did not fit the defined categories (Figure 2).
Based on the incidence of cardiac anomalies, prenatal echocardiogram had a positive predictive value (PPV) of 93% [68-99%], negative predictive value (NPV) of 76% [57-89%], sensitivity of 68% [46-85%] and specificity of 95% [76-99%] for finding the described anomalies (p < 0.0001).
Of the 37 patients who had both prenatal and postnatal echocardiograms, 5 (14%) had findings identified postnatally that were not seen prenatally. The missed anomalies were all ventricular septal defects (VSD), and only one resulted in a reconsideration of the preoperative management. For that patient, cardiac anesthesia was consulted but not required for CDA repair. While some VSDs resolved between the prenatal and postnatal echocardiograms, there were no false positive findings prenatally.

Conclusion: A postnatal echocardiogram is unlikely to identify cardiac anomalies not seen prenatally that are significant enough to result in a change in management prior to surgery for CDA. Our data suggests that surgical repair of CDA may not need to be delayed to obtain a postnatal echocardiogram if a prenatal echocardiogram has been performed.