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Most congenital heart defects (CHD) are detected during pregnancy in developed countries. Several causes such as maternal and pregnancy characteristics and quality of screening practices are well known to be barriers to prenatal screening for such malformations. The aims of our study are: 1/to perform an audit in Southeast France of prenatal ultrasonographic practices of CHD diagnosed postnatally and requiring an intervention during the first year of life and analyzing causes for such misdiagnosis and 2/to evaluate the potential use of an AI program to improve the detection of those cases. Between 01/01/2020 and 12/31/2021, 104 children (n = 104) are referred in our tertiary pediatric cardiologic center with a postnatal diagnosis of CHD requiring surgical or percutaneous intervention in their first year of life. Postnatal diagnosis includes among others: transposition of the great arteries (n = 5), tetralogy of Fallot (7), and total abnormal pulmonary venous return (n = 11). Focus will be on the number and quality of the prenatal ultrasonographic images and their adequation with ISUOG practice guidelines. AI programs will subsequently be tested in its ability to cope with these technical problems, heighten the sensitivity of the screening and improve detection of such missed CHD. Parental and obstetrician's consent has been obtained. Our study will allow us to understand better the reasons for the under-diagnosis of CHD in southeastern France and to test the possible role of AI programs in this perspective. [ABSTRACT FROM AUTHOR]

Background: Recent data suggest that fractional flow reserve (FFR) is useful in guiding coronary revascularization. There is however currently no large report of the use of this technology in France, in particular its impact on the decision of coronary revascularization. Methods: The R3F registry investigated the use of FFR in 20 French centers from October 2008 to June 2010. To investigate this issue the investigators defined prospectively their revascularization strategy “a priori” before performing the FFR. This was compared to the final strategy applied to the patient after performing the FFR. The results of the first 945 consecutive patients are presented. Results: 75% of patients were males with a mean age of 65 ± 10 years, 37% were diabetics and 19% had a recent ACS. Patients had non-significant (< 50% stenosis) angiographic coronary artery disease (14%), significant (>50%) angiographic 1-vessel (37%), 2-vessel (30%) or 3-vessel disease (19%). The strategy defined “a-priori” by the investigators was medical therapy (52%), PCI (37%), and CABG (11%). After the results of FFR the final strategy was medical therapy in 58% and coronary revascularization in 42% (PCI in 31% and CABG in 11%). Interestingly in 45% of cases the strategy defined “a priori” was modified by the results of the FFR: [1)] In 36% of the patients in which a medical therapy was planed “a priori” the strategy was modified for PCI (26%) or CABG (10%); [2)] In 58% of the patients in which a PCI was considered “a priori” the strategy was modified for medical therapy (50%) or CABG (8%); [3)] In 68% of the patients in which a CABG was considered “a priori” the strategy was modified for medical therapy (64%) or PCI (4%). Conclusion: The present report, based on a large French multicenter registry, demonstrated that although FFR had little impact on the overall rate of revascularization, it modified the individual decision in almost 1 out of 2 patients. [Copyright &y& Elsevier]