Variation of Prenatal Detection of Congenital Heart Disease in Infants: Updated Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database

Background: Prenatal detection rates of congenital heart disease (CHD) in patients requiring early surgical intervention have been suboptimal, with variability between geographic regions and across defect types. In 2013, obstetric screening ultrasound guidelines were updated, recommending the addition of outflow tract views to improve prenatal detection rates. The objective of this study was to evaluate prenatal detection rates before and after the introduction of outflow tract views in obstetric screening examinations. Methods: In The Society of Thoracic Surgeons Congenital Heart Surgery Database (between January 1, 2006, and June 30, 2023, inclusive), patients <183 days old undergoing index procedures at US centers were identified. Prenatal detection rates were assessed overall, by year, by geographic location, and by lesion type and were further stratified by whether the anomaly is considered to be detectable on the 4-chamber view. Results: The study included 108,512 patients at 123 centers. Prenatal detection rates of CHD continuously increased during the study time frame. Prenatal detection rates varied by region (43.6%-56.2%) and lesion type (13.1%-77.1%). Prenatal detection rates have increased for lesions not routinely detected on a 4-chamber view but visible on outflow tract views in comparison to those routinely detected on a 4-chamber view (P = .029). Conclusions: Prenatal detection rates of CHD have generally increased over time, particularly for lesions requiring outflow tract views relative to lesions routinely detectable on the 4-chamber view. Prenatal detection rates for some forms of CHD remain suboptimal and require ongoing quality improvement efforts. Further investigation of the potential impact of increasing prenatal detection rates on outcomes is warranted.