Telediagnosis system for congenital heart disease in a Japanese prefecture
Mabuchi A, Waratani M, Tanaka Y, Mori T, Kitawaki J.J Med Ultrason (2001). 2020 Apr 23. doi: 10.1007/s10396-020-01020-y.
Online ahead of print.
Take Home Points
- Fetal diagnosis via telehealth using 3D images transferred via an optical fiber network system is feasible and reliable.
- In 161 cases screened, cardiac defects were noted in 24 fetal scans. Though there were some discrepancies in prenatal cardiac diagnosis versus post-natal diagnosis, no significant cardiac abnormalities were missed.
- Appropriate post-natal planning was performed using the telehealth fetal images with significant cardiac defects birthed at a tertiary pediatric hospital whereas minor cardiac defects were birthed at the home hospital.
Commentary from Dr. Clifford Cua (Columbus, OH), Section Editor of Pediatric Cardiology Journal Watch: In this retrospective study from a single institution, Kyoto Prefectural University of Medicine, a spatio-temporal image correlation (STIC) based tele-diagnosis system was created for remote fetal diagnostic purposes. STIC is a 3D technique of acquiring structural and temporal data using a single scan. Data are digitized and cross-sectional images can be reconstructed to be reviewed at a later date. This system was created to help screen fetal cardiac exams from distant locations from the main pediatric cardiac hospital to maximize care and minimize unnecessary travel for the families.
A total of 182 fetal scans over a nine-year period (2009 – 2018) were referred for evaluation from six hospitals within the Kyoto Prefecture. 21 cases were excluded (10 – error in transmission, 11 – no postnatal diagnosis available), therefore 161 cases were studied. Images were obtained via a Voluson E7, E8, or E10 (GE Medical Systems) and transferred images were reviewed by a pediatric cardiologist within 24 to 72 hours from transmission. Images were evaluated using a standard protocol to assess the cardiac anatomy.
Cardiac disease was noted 14.9% of cases (24/161) and accuracy of diagnosis was 95.0% (153/161). In four cases, the cardiac diagnosis changed from prenatal to post-natal: (1) double outlet right ventricle (DORV) to ventricular septal defect (VSD); (2) DORV and pulmonary artery stenosis (PS) to single ventricular and tricuspid atresia; (3) transposition of the great arteries (TGA) to DORV and PS; and (4) total anomalous pulmonary venous connection to normal heart after the visit. In another four cases, the prenatal diagnosis was thought to be normal, but postnatally, two patients had a VSD, one had an ASD, and one patient an aneurysm of the PDA. Seven cases suspected of having severe cardiac issues were delivered at the tertiary pediatric hospital whereas the other patients birthed at their respective home hospitals experienced no adverse outcomes.
This study is limited by its retrospective nature, single center evaluation, and relatively small cases evaluated. That being said, this paper adds more evidence that tele-health for fetal cardiac screening purposes is feasible and allows for efficiency of medical care for both the family and health professional.