| 1. |
- El-Segaier, Milad, et al.
(författare)
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Atrial septal defect: a diagnostic approach
- 2006
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Ingår i: Medical & Biological Engineering & Computing. - : Springer Science and Business Media LLC. - 0140-0118 .- 1741-0444. ; 44:9, s. 739-745
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Tidskriftsartikel (refereegranskat)
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| 2. |
- El-Segaier, Milad, et al.
(författare)
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Cardiac rhabdomyoma mimicking haemodynamics of hypoplastic left heart syndrome
- 2014
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Ingår i: Acta Cardiologica. - 0001-5385. ; 69:3, s. 308-310
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Tidskriftsartikel (refereegranskat)abstract
- Cardiac rhabdonnyomas are rare and often regress spontaneously. However, the management of rhabdomyoma with severe inflow and outflow obstructions is a challenge. An infant with a massive left ventricular rhabdomyoma mimicking the haemodynamics of hypoplastic left heart syndrome is reported. Surgery could not be contemplated because the mitral valve leaflets and chordae were imbedded in the tumour mass. The arterial duct (AD) was kept open to perfuse the systemic circulation and palliations with pulmonary artery branch banding and AD stenting were planned. However; while waiting for spontaneous regression of the tumour, the child died of circulatory collapse when 4 weeks old.
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| 3. |
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| 4. |
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| 5. |
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| 6. |
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| 7. |
- El-Segaier, Milad, et al.
(författare)
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Detection of cardiac pathology: time intervals and spectral analysis.
- 2007
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Ingår i: Acta Pædiatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 96:7, s. 1036-1042
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To develop an objective diagnostic method that facilitates detection of noncyanotic congenital heart diseases. METHODS: Heart sounds and murmurs were recorded from 60 healthy children and 173 children with noncyanotic congenital heart disease. Time intervals were measured and spectrum of the systolic murmurs analyzed. Stepwise logistic regression analysis was used to distinguish physiological from pathological signals. The receiver operating characteristic (ROC) curve was plotted to show the classification performance of the model and the area under the curve (AUC) was calculated. The probability cut-off points for calculation of sensitivities and specificities were estimated. RESULTS: The distinguishing variables were the interval from the end of the first heart sound (S(1)) and the beginning of the systolic murmur, respiratory variation of the splitting of the second heart sound, intensity of the systolic murmur, and standard deviation of the interval from the end of the S(1) to the maximum intensity of the murmur. The AUC was 0.95, indicating an excellent classification performance of the model. The sensitivity of 95% and specificity of 72% was achieved at a probability cut-off point of 0.45. Significant cardiac defects were correctly classified. CONCLUSION: Interval measurements and spectral analysis can be used to confirm significant noncyanotic congenital heart diseases. Further development of the method is necessary to detect also insignificant heart defects.
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| 8. |
- El-Segaier, Milad
(författare)
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DIGITAL ANALYSIS OF CARDIAC ACOUSTIC SIGNALS IN CHILDREN
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- DIGITAL ANALYSIS OF CARDIAC ACOUSTIC SIGNALS IN CHILDREN Milad El-Segaier, MD Division of Paediatric Cardiology, Department of Paediatrics, Lund University Hospital, Lund, Sweden SUMMARY Despite tremendous development in cardiac imaging, use of the stethoscope and cardiac auscultation remains the primary diagnostic tool in evaluation of cardiac pathology. With the advent of miniaturized and powerful technology for data acquisition, display and digital signal processing, the possibilities for detecting cardiac pathology by signal analysis have increased. The objective of this study was to develop a simple, cost-effective diagnostic tool for analysis of cardiac acoustic signals. Heart sounds and murmurs were recorded in 360 children with a single-channel device and in 15 children with a multiple-channel device. Time intervals between acoustic signals were measured. Short-time Fourier transform (STFT) analysis was used to present the acoustic signals to a digital algorithm for detection of heart sounds, define systole and diastole and analyse the spectrum of a cardiac murmur. A statistical model for distinguishing physiological murmurs from pathological findings was developed using logistic regression analysis. The receiver operating characteristic (ROC) curve was used to evaluate the discriminating ability of the developed model. The sensitivities and specificities of the model were calculated at different cut-off points. Signal deconvolution using blind source separation (BSS) analysis was performed for separation of signals from different sources. The first and second heart sounds (S1 and S2) were detected with high accuracy (100% for the S1 and 97% for the S2) independently of heart rates and presence of a murmur. The systole and diastole were defined, but only systolic murmur was analysed in this work. The developed statistical model showed excellent prediction ability (area under the curve, AUC = 0.995) in distinguishing a physiological murmur from a pathological one with high sensitivity and specificity (98%). In further analyses deconvolution of the signals was successfully performed using blind separation analysis. This yielded two spatially independent sources, heart sounds (S1 and S2) in one component, and a murmur in another. The study supports the view that a cost-effective diagnostic device would be useful in primary health care. It would diminish the need for referring children with cardiac murmur to cardiac specialists and the load on the health care system. Likewise, it would help to minimize the psychological stress experienced by the children and their parents at an early stage of the medical care.
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| 9. |
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| 10. |
- El-Segaier, Milad, et al.
(författare)
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Late coronary complications after arterial switch operation and their treatment.
- 2010
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Ingår i: Catheterization and Cardiovascular Interventions. - : Wiley. - 1522-726X .- 1522-1946. ; 76, s. 1027-1032
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES:: To report the late coronary complications and their treatment after ASO. BACKGROUND:: Asymptomatic patients after arterial switch operation (ASO) may have coronary ostial stenosis or obstruction. METHODS:: Since 1980, 279 patients were operated with ASO. At the time of preparing this article, selective follow-up coronary angiograms were done on 81 patients. RESULTS:: Coronary stenosis was found in six patients. A six year-old patient with left coronary artery (LCA) ostial stenosis and a nine year-old patient with conus branch occlusion had good collaterals without a need for further treatment. One patient with LCA obstruction, myocardial infarction, and left ventricular failure was operated with osteoplasty at age of 16 years. In three essentially asymptomatic patients stenting of LCA ostium stenosis was done: in two of them with drug-eluting stents at nine and ten years of age and in one with bare-metal stent at 18 years of age. One of these patients was earlier treated with balloon dilatation at five years of age which caused intimal dissection. CONCLUSIONS:: Asymptomatic patients with an uneventful course after ASO may have coronary obstruction. This necessitates follow-up coronary evaluation in all patients. Stenting of the coronary arteries is an option for treatment. (c) 2010 Wiley-Liss, Inc.
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| 11. |
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| 12. |
- El-Segaier, Milad, et al.
(författare)
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Recanalization of arterial duct is feasible, effective and its potential risks are treatable
- 2015
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Ingår i: Acta Cardiologica. - 0001-5385. ; 70:1, s. 13-19
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Tidskriftsartikel (refereegranskat)abstract
- Background Recanalization of arterial duct (AD) is rarely needed. Objective The aim of this study is to report our experience regarding the feasibility and effectiveness of arterial duct recanalization in three infants and review the relevant literature. Methods and results We report on three patients with decreased pulmonary blood flow after initial palliation. The first patient had pulmonary atresia (PA) and an intact ventricular septum. He needed recanalization of the AD after pulmonary valve perforation and dilatation. The second patient had PA and ventricular septal defect (VSD). His AD originated from the left subclavian artery. He required AD recanalization after palliation with a central shunt and clipping of the duct. During intervention he developed a thrombus in the stent, which was treated successfully using thrombolytic treatment. The third patient had PA and VSD. The arterial duct originated from the left subclavian artery and was recanalized after spontaneous closure despite prostaglandin infusion. During the procedure the patient had severe desaturation and bradycardia requiring resuscitation for two minutes. All infants had successful arterial duct recanalization and stenting. Additionally, they were clinically stable during follow-up. Conclusion Arterial duct recanalization and stenting is a feasible and effective procedure in selected cases, and its risks are treatable. Long-term studies are required.
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| 13. |
- El-Segaier, Milad, et al.
(författare)
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Recombinant Tissue Plasminogen Activator in the Treatment of Neonates with Intracardiac and Great Vessels Thrombosis
- 2015
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Ingår i: Pediatric Cardiology. - : Springer Science and Business Media LLC. - 0172-0643 .- 1432-1971. ; 36:8, s. 1582-1587
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Tidskriftsartikel (refereegranskat)abstract
- Life-threatening intracardiac and great vessels thrombi are rare in neonates. Recombinant tissue plasminogen activator (rTPA) is used in adults to stimulate fibrinolysis and facilitate thrombus resolution. Its use in neonates, along with heparin, remains controversial because of potential risk of serious bleeding. We aim to present our experience with the use of thrombolytic agents in seven neonates and young infants. In a retrospective study, over a period of 6 years, the medical records of neonates and young infants, who were diagnosed with intracardiac and great vessels thrombi, were reviewed. The following factors were collected: demographic data, primary diagnosis, thrombus site, risk factors, method of diagnosis, thrombolytic and/or anticoagulation agent, route, dose and duration of treatment, complications, and outcome. Six neonates and one 45-day-old infant were analyzed. Age ranged from 5 to 45 days (median age 12 days), and median weight was 2.9 kg (range 0.9-3.8 kg). The thrombi were diagnosed by echocardiography in five and by angiography in two cases. All patients had life-threatening thrombi; four were treated with rTPA (0.5 mg kg(-1) h(-1)) and heparin infusions with complete dissolution of the thrombi, within a median time of 60 h (6-72 h), and without complications. The remaining three patients (two who were premature, at 28 and 34 weeks of gestation, and the third who had a deranged coagulation profile) were treated with unfractionated heparin due to fear of bleeding. The thrombi dissolved in the premature babies (within 2 weeks and 3 months, respectively) but embolized and resulted in the death of the third infant after 2 weeks of treatment. The current case series confirmed the effectiveness and safety of intravenous rTPA infusion, at the dosages used, in neonates and young infants with life-threatening thrombi.
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| 14. |
- Eldin, Ghada Shiekh, et al.
(författare)
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High prevalence rate of left superior vena cava determined by echocardiography in patients with congenital heart disease in Saudi Arabia
- 2013
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Ingår i: Libyan Journal of Medicine. - : Informa UK Limited. - 1993-2820 .- 1819-6357. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Background: Persistent left superior vena cava (LSVC) is one of the common anomalies of the systemic veins. Its prevalence is 0.1-0.3% in the general population and is more common with congenital heart disease (CHD). The importance of detecting persistent LSVC prior to cardiac surgery is paramount for systemic veins cannulations. Aim: The aim was to evaluate the prevalence of persistent LSVC in patients with CHD in Saudi Arabia. Methods: All patients referred to our institution had echocardiography. All complete studies were reviewed for the presence of persistent LSVC. A computerized database was created including the demographic data, CHD diagnoses, and the presence of persistent LSVC. Results: A total of 2,042 were examined with an age range of 1 day to 16 years. The complete echocardiographic studies were 1,832 (90%) of whom 738 (40%) patients had CHD. The prevalence of persistent LSVC in patients with CHD was 7.8% (OR 9.26, 95% CI 4.7-18.2, p <0.001). The most common cardiac defect associated with persistent LSVC was complete atrioventricular septal defect (AVSD); all patients with AVSD had Down syndrome. The total number of patients with AVSD was 41, and persistent LSVC was found in 11 (26%) of them (odds ratio 5.1, 95% CI 2.4-10.8, p <0.001). Conclusions: The prevalence of persistent LSVC in the current population is almost double the reported prevalence obtained using the same echocardiographic screening tool.
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| 15. |
- Elhoury, Motea E., et al.
(författare)
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Combined Semilunar Valve Stenoses in Neonates: Management Approaches and Literature Review
- 2014
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Ingår i: Pediatric Cardiology. - : Springer Science and Business Media LLC. - 0172-0643 .- 1432-1971. ; 35:8, s. 1469-1473
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Forskningsöversikt (refereegranskat)abstract
- Combination of right and left ventricular outflow tracts obstruction is extremely rare. Neonates with combined aortic stenosis (AS) and pulmonary stenosis (PS) present in critical condition and required urgent treatment. The management approach is not well defined. We report five female neonates with combined AS and PS presented to our institute in the last 5 years, age (1-18 days), weight (2.2-3.4 kg). Two had associated muscular ventricular septal defects. The mean Doppler gradient across the aortic valve (AV) was 73 mmHg (53-105 mmHg) and across the pulmonary valve was 62 mmHg (44-76 mmHg). Three had balloon dilatation and one surgical repair. The fifth patient was managed conservatively, but had sudden cardiac death at age of 3 months. One patient arrived in shock and sepsis, underwent emergency balloon dilation of the AV in the ICU. Despite decreasing the gradient, she died next day after the procedure. The surviving children were well at median follow-up age of 3.4 years. This is an extremely rare combination which needs early intervention. The management approach is not well defined. Interventional catheterization is possibly the better option.
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| 16. |
- Elhoury, Motea E, et al.
(författare)
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Impact of Interatrial Communication on Left Ventricle Performance in Patients with Significant Post-tricuspid Shunt.
- 2016
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Ingår i: Pediatric Cardiology. - : Springer Science and Business Media LLC. - 0172-0643 .- 1432-1971. ; 37:3, s. 582-592
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Tidskriftsartikel (refereegranskat)abstract
- Infants with post-tricuspid valve shunts (PTS) may benefit from interatrial communication (IAC). The effect of IAC on left ventricular (LV) performance in these patients was studied. IAC was documented prospectively in 55 patients with PTS. Clinical status, echocardiographic dimensions of LV, mitral inflow Doppler, tissue Doppler velocities and time intervals were measured. Creatinine kinase (CK), CKMB, troponin-I and NT pro-brain natriuretic peptide (NT pro-BNP) were measured. Patients were divided into four groups: (A) PTS but no IAC (n = 32); (B) PTS and IAC (n = 23); (C) VSD but no IAC (n = 16); and (D) VSD and IAC (n = 19). Group A had more frequent mitral regurgitation (p = 0.041), larger mitral annulus (1.80 vs. 1.30 cm, p < 0.0001) and larger LV systolic and diastolic dimensions (2.01 vs. 1.40 and 3.28 vs. 2.35 cm, p < 0.001) than group B. The E-wave deceleration time tended to be longer in group A (121.0 vs. 106.8 ms, p = 0.06). By tissue Doppler, group A had E'- and S-waves significantly taller (15.51 vs. 13.14 and 7.69 vs. 6.72 cm, p = 0.04 and p = 0.005, respectively) than group B. Also, NT pro-BNP was significantly higher in group A (1116.15 vs. 458.73 pg/ml, p = 0.028). Group C had significant larger mitral z-score values (1.2 vs. 0.01, p < 0.001), larger LV diameter z-score (p = 0.001) and higher NT pro-BNP level (1477.37 vs. 451.66 pg/ml, p = 0.001) than group D. There was no significant difference in the clinical status between the groups. In children with PTS, the presence of IAC could be beneficial. Their echocardiographic parameters and biomarker show better systolic and diastolic LV performance.
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| 17. |
- Galal, Mohammed Omar, et al.
(författare)
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Percutaneous closure of atrial septal defect with situs solitus and dextrocardia.
- 2015
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Ingår i: Asian cardiovascular & thoracic annals. - : SAGE Publications. - 1816-5370 .- 0218-4923. ; 23:2, s. 202-205
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Tidskriftsartikel (refereegranskat)abstract
- Percutaneous closure of secundum atrial septal defect associated with situs solitus and dextrocardia has not been reported previously. We describe the technical difficulties encountered during transcatheter closure of a secundum atrial septal defect in a 19-month-old girl with situs solitus and dextrocardia.
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| 18. |
- Harling, Solweig, et al.
(författare)
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Quantification of left-to-right shunt through patent ductus arteriosus by colour Doppler in children admitted for a device closure
- 2012
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Ingår i: Cardiology in the Young. - 1467-1107. ; 22:1, s. 57-62
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Our animal model suggests that quantification of ductal flow from colour Doppler pixels is possible. We aimed to clarify whether this method can be used to determine a clinically significant ductal shunt in children. Methods: We retrospectively quantified ductal flow from saved images from 20 children who had been admitted for device occlusion of patent ductus arteriosus. Colour Doppler images over the main stem of the pulmonary artery were obtained in longitudinal cross-sections. The colour pixel percentages during diastole, representing ductal flow, were correlated with the documented shunt, measured invasively according to Fick's principle. Results: The ratio of pulmonary to systemic flow correlated best with the sum of the percentages of green colour pixels (r = 0.73, r(2) = 0.54, p < 0.001). When the shunt was 1.5:1 or more, 12 out of 13 infants had 50% or more of the region of interest covered with green pixels - sensitivity 92%, specificity 71%. The correlation between ductal diameter and pulmonary-to-systemic flow ratio was less significant (r = 0.6, r(2) = 0.37, p < 0.03). Conclusions: We conclude that clinically significant shunts with pulmonary-to-systemic flow ratio over 1.5 can be diagnosed with this method where neither the size of the patient nor echocardiographic settings seem to be critical. The method could be used to provide an objective indication for ductal closure, but further prospective studies in children are needed to verify the power of the method.
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| 19. |
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| 20. |
- Jadoon, Shehla, et al.
(författare)
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Paediatricians' referral preference of patients with embolised intravascular foreign bodies: a survey-based study
- 2013
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Ingår i: Libyan Journal of Medicine. - : Informa UK Limited. - 1993-2820 .- 1819-6357. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Background: Central line insertion is a routine procedure in medical practice. Dislodgement of lines into the vascular system is a rare complication. We noticed that paediatric health care providers (PHCP) contact the cardiac or general paediatric surgeon for extraction of dislodged lines more frequently than using the less invasive percutaneous approach. Aim: To study the referral preference of PHCP for patient with embolised intravascular foreign bodies. Methods: A questionnaire with three questions was distributed to PHCP of all paediatric subspecialties, including surgery, in two tertiary care centres. The questions were about the total number of patients seen with central line, experience with complications, and preferred specialty for removal of dislodged central lines. Results: The questionnaire was distributed to 128 professionals. The response rate was 79% (n = 101). Incomplete answers (n = 14) were excluded. The grades of responders were senior consultants 18%, junior consultants 38%, and residents 43%. Thirty nine percent of care providers experienced dislodgement or fragmentation of central lines. The majority (82%) prefer to refer the patients for surgical removal. Conclusions: Most PHCP in the selected hospitals prefer to refer patients with embolised foreign bodies in the vascular system for surgical removal. The local health policy should be updated for the use of the alternative percutaneous approach.
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| 21. |
- Lahdesmaki, A, et al.
(författare)
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Ataxia-telangiectasia kartlagd i Sverige
- 2000
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Ingår i: Läkartidningen. - 0023-7205. ; 97:40, s. 4461-4467
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Tidskriftsartikel (refereegranskat)abstract
- Ataxia-telangiectasia (AT) is a rare autosomal recessive disease with a complex phenotype involving cerebellar degeneration, immunodeficiency, cancer risk and radiosensitivity. Our aim has been to identify Swedish AT patients in order to study the possible "Swedish phenotype" of the disease. In the 19 patients identified in Sweden we found a phenotype fairly similar to what has been described internationally, with the exception of some differences including lower cancer incidence in patients and their relatives and somewhat more pronounced immunodeficiency and concomitant susceptibility to infections.
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| 22. |
- Pesonen, Erkki, et al.
(författare)
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Infections as a stimulus for coronary occlusion, obstruction, or acute coronary syndromes.
- 2009
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Ingår i: Therapeutic Advances in Cardiovascular Disease. - : SAGE Publications. - 1753-9447 .- 1753-9455.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: : Atherosclerosis is considered to be an inflammatory disease. Infections are a significant cause of inflammation. Acute infections might precipitate acute coronary syndromes (ACS) whereas chronic infections might be stimuli for the development of atherosclerosis. METHODS: : Coronary angiograms were done on 211 of 335 patients with ACS and the percentage of coronary obstruction was determined. Serum antibody levels to Chlamydia pneumoniae, C. pneumoniae heat shock protein 60 (CpnHSP60), human heat shock protein 60 (hHSP60), enterovirus (EV), herpes simplex virus (HSV), cytomegalovirus (CMV), and two major periodontal pathogens, Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, were measured in healthy controls (n = 355) and all patients. RESULTS: : Serum antibody levels to periodontal pathogens did not correlate with ACS. However, IgA-class antibody levels to Aggregatibacter actinomycetemcomitans (p = 0.021), CpnHSP60 (p = 0.048) an hHSP60 (p = 0.038) were higher in patients with coronary occlusion or obstruction compared to those without any obstruction. Odds ratios for coronary changes in the highest quartile as compared to the lower quartiles were for A. actinomycetemcomitans IgA 7.84 (95% CI 1.02-60.39, p = 0.048), for CpnHSP60 IgA 8.61 (1.12-65.89, p = 0.038), and for human HSP60 IgA 3.51 (0.79-15.69, p = 0.100). CONCLUSIONS: : We have previously reported that EV and HSV titres correlated significantly to acute coronary events. They do not correlate to the degree of coronary obstruction as shown here. However, infection by A. actinomycetemcomitans or C. pneumoniae or host response against them associated with coronary obstruction. Clinical coronary events may arise by the effect of acute infections and obstructing lesions by a chronic inflammatory stimulus.
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| 23. |
- Pietila, A, et al.
(författare)
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Blind source separation of cardiac murmurs from heart recordings
- 2006
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Ingår i: Independent Component Analysis and Blind Signal Separation. Proceedings (Lecture Notes in Computer Science). - Berlin, Heidelberg : Springer Berlin Heidelberg. - 1611-3349 .- 0302-9743. - 9783540326304 ; 3889, s. 470-477
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Konferensbidrag (refereegranskat)abstract
- A significant percentage of young children present cardiac murmurs. However, only one percent of them are caused by a congenital heart defect; others are physiological. Auscultation of the heart is still the primary diagnostic tool for judging the type of cardiac murmur. An automated system for an initial recording and analysis of the cardiac sounds could enable the primary care physicians to make the initial diagnosis and thus decrease the workload of the specialised health care system. The first step in any automated murmur classifier is the identification of different components of cardiac cycle and separation of the murmurs. Here we propose a new methodological framework to address this issue from a machine learning perspective, combining Independent Component Analysis and Denoising Source Separation. We show that such a method is rather efficient in the separation of cardiac murmurs. The framework is equally capable of separating heart sounds S1 and S2 and artifacts such as voices recorded during the measurements.
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| 24. |
- Sorensen, Karina Meden, et al.
(författare)
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Screening of Congenital Heart Disease Patients Using Multiplex Ligation-Dependent Probe Amplification: Early Diagnosis of Syndromic Patients
- 2012
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Ingår i: American Journal of Medical Genetics. Part A. - : Wiley. - 1552-4825. ; 158A:4, s. 720-725
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Tidskriftsartikel (refereegranskat)abstract
- Recurrent copy number variants (CNVs) are found in a significant proportion of patients with congenital heart disease (CHD) and some of these CNVs are associated with other developmental defects. In some syndromic patients, CHD may be the first presenting symptom, thus screening of patients with CHD for CNVs in specific genomic regions may lead to early diagnosis and awareness of extracardiac symptoms. We designed a multiplex ligation-dependent probe amplification (MLPA) assay specifically for screening of CHD patients. The MLPA assay allows for simultaneous analysis of CNVs in 25 genomic regions previously associated with CHD. We screened blood samples from 402 CHD patients and identified 14 rare CNVs in 13 (3.2%) patients. Five CNVs were de novo and six where inherited from a healthy parent. The MLPA screen led to early syndrome diagnosis in two of these patients. We conclude that the MLPA assay detects clinically relevant CNVs and suggest that it could be used within pediatric cardiology as a first tier screen to detect clinically relevant CNVs and identify syndromic patients at an early stage. (C) 2012 Wiley Periodicals, Inc.
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| 25. |
- Öhman, Annika, et al.
(författare)
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Changing Epidemiology of Hypoplastic Left Heart Syndrome : Results of a National Swedish Cohort Study
- 2019
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Ingår i: Journal of the American Heart Association. - : John Wiley & Sons. - 2047-9980. ; 8:2
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Tidskriftsartikel (refereegranskat)abstract
- Background Norwood surgery provides a palliative surgical option for hypoplastic left heart syndrome and has been available in Sweden since 1993. The practice of prenatal ultrasound screening was gradually implemented in the same era, resulting in an increased prenatal detection rate. Our primary aims were to study changes in the incidence of live births, prenatal detection rate, and the termination of pregnancies over time. The secondary aims were to study the proportion of live-borns undergoing surgery and to identify factors that influenced whether surgery was or was not performed. Methods and Results Neonates with hypoplastic left heart syndrome with aortic atresia born 1990-2010 were identified through national databases, surgical files, and medical records. The fetal incidence was estimated from the period when prenatal screening was rudimentary. The study period was divided into the presurgical, early surgical, and late surgical periods. The incidence was calculated as the overall yearly incidence for each time period and sex separately. Factors influencing whether surgery was performed were analyzed using Cox-logistic regression. The incidence at live birth decreased from 15.4 to 8.4 per 100 000. The prenatal detection rate increased from 27% to 63%, and terminations increased from 19% to 56%. The odds of having surgery was higher in the late period and higher in the group with prenatal diagnosis. Conclusions We observed a decrease in incidence of live-borns with hypoplastic left heart syndrome aortic atresia. There was in increase in prenatal detection rate and an increase in termination of pregnancy. The proportion of live-borns who underwent surgery increased between time periods.
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