Prenatal ultrasound risk factors for predicting postnatal heart failure in patients with congenital hepatic hemangiomas: a single-center study.
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BACKGROUND: Congenital hepatic hemangiomas (CHHs) represent a rare subset of vascular tumors that, despite often demonstrating a favorable natural history, can precipitate life-threatening complications in neonates. However, a comprehensive delineation of specific prenatal sonographic features that reliably predict the development of postnatal heart failure remains inadequately explored. This study aimed to identify and quantify key prenatal ultrasound risk factors associated with the onset of postnatal heart failure in fetuses diagnosed with CHHs, thereby facilitating early risk stratification and potential prenatal intervention. METHODS: Patients with CHHs who were diagnosed at or referred to our hospital by prenatal ultrasound between 2019 and 2023 were followed-up. The age of the pregnant women and the gestational age (GA) at the first detection of the mass, as well as the ultrasound characteristics, clinical manifestations, and outcomes of the children were collected. Patients were categorized into asymptomatic and concomitant heart failure groups according to their postpartum condition. Statistical methods were used to analyze the differences in prenatal ultrasound between the 2 groups. RESULTS: A cohort of 54 patients was finally included. Multiple prenatal parameters significantly predicted congestive heart failure (CHF). The heart failure group had a larger median tumor diameter (6.5 vs. 3.8 cm; P=0.001). Receiver operating characteristic (ROC) analysis identified a tumor diameter >4.85 cm as predictive of CHF (area under the curve =0.859, sensitivity 100%, specificity 70.2%). The cardiothoracic ratio was significantly elevated in the heart failure group (median 0.40 vs. 0.27; P<0.0001). The presence of portal-systemic venous shunts (PSVSs) (100% vs. 19.1%; P<0.0001), venous lakes (100% vs. 10.6%; P<0.0001), hepatic vein dilation (100% vs. 48.9%; P=0.013), and hepatic artery dilation (100% vs. 36.2%; P=0.002) were all significantly associated with CHF. A dual portal vein and hepatic artery blood supply was more frequent in the heart failure group (57.1% vs. 12.8%; P=0.017). Hepatic artery dilation was correlated with the hepatic artery blood supply, venous lakes, and hepatic vein dilation. CONCLUSIONS: Children with CHHs who develop heart failure after birth were identified as having changed prenatal ultrasound characteristics. This information will aid in the early clinical management of such patients to improve their prognosis.