Diagnosis, transport, and outcome in fetuses with left ventricular outflow tract obstruction

Chang, Anthony; Huhta, James C.; Yoon, Grace Y.; Wood, Dennis; Tulzer, Gerald; Cohen, Arnold W.; Mennuti, Michael T.; Norwood, William I.

doi:10.1016/s0022-5223(19)33933-9

Cited by 105 publications

(31 citation statements)

References 16 publications

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“…Ideally, this is best managed by a nurse or counsellor who is familiar with the patient. If a cardiac malformation is 'duct-dependent', that is, either the systemic or pulmonary circulation is supplied or augmented by ductal flow, it is optimum to deliver the mother at, or near, the cardiac centre where surgical intervention will take place (Chang et al, 1991;Bonnet, 1999;see Yates, this issue, pages 1143see Yates, this issue, pages -1149. When the decision has been made to deliver in the tertiary centre, transfer is usually arranged between 30 and 34 weeks' gestation, to minimally inconvenience the mother, but at the same time to allow her to become familiar with a new obstetrician and hospital in time for her delivery.…”

Section: Management Optionsmentioning

confidence: 99%

Counselling following a diagnosis of congenital heart disease

Allan

Huggon

2004

Prenatal Diagnosis

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Counselling the parents following a diagnosis of fetal congenital heart disease (CHD) is as important a task for the fetal cardiologist, as the skill involved in achieving an accurate diagnosis. The counsellor will base prognosis not only on the diagnosis itself but also on the security of diagnosis, the stage in gestation and potential for change, the association with extracardiac malformations and the known results of treatment. Depending on the gestational age and legal situation the counsellor is operating in, termination of pregnancy may be one of the options to consider and one that should always be raised in discussion. Thus, the parents may be in the position of making a crucial decision concerning the management of the pregnancy on the basis of the information received, so it is vital that the counsellor is truly able to communicate with them, whatever be their level of understanding.

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Section: Management Optionsmentioning

confidence: 99%

Counselling following a diagnosis of congenital heart disease

Allan

Huggon

2004

Prenatal Diagnosis

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“…In the vast majority of cases of HLHS diagnosed prenatally at our center, the parents opt for delivery at the cardiac center to avoid the need for postnatal transfer of the baby and, importantly, to avoid potential separation of the parents and baby. The advantages of this approach have been described previously 21 . Following delivery, a prostaglandin E infusion is commenced to maintain ductal patency and the prenatal diagnosis of HLHS is confirmed echocardiographically.…”

Section: Postnatal Treatment Strategiesmentioning

confidence: 99%

Hypoplastic left heart syndrome

Simpson

2000

Ultrasound in Obstet & Gyne

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Hypoplastic left heart syndrome may be accurately diagnosed during fetal life. Prenatal diagnosis provides the opportunity for parents to make an informed choice about their options, including surgery, nonintervention postnatally or termination of pregnancy. Short to medium term survival continues to improve for a condition that was previously invariably lethal. There continues to be a significant mortality and morbidity associated with hypoplastic left heart syndrome, and the long-term prognosis is unknown. Knowledge of the condition prior to birth means that babies who are to undergo surgery present in optimal condition for such interventions. Parents who have had an affected fetus or child should be offered detailed fetal echocardiography to exclude a recurrence in subsequent pregnancies.

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“…In such centers, these babies can be safely delivered in an optimum environment, with the cardiac surgical team already alerted and ready to act. From the viewpoint of the cost analysts, there is little doubt that such management of pregnancies complicated by fetal congenital heart disease represents a powerful system to reduce significantly the costs, since all expenditures due to emergency transfer of diseased neonates by air or ground ambulances are spared and the cost of intensive care unit procedures are greatly reduced [8][9][10] . At the same time, the life expectancy of neonates with prenatally detected lesions increases.…”

Section: Editorial Paladinimentioning

confidence: 99%

Prenatal screening of congenital heart disease between ethics and cost‐effectiveness. Time for a change in current prenatal ultrasound screening policies?

Paladini

1999

Ultrasound in Obstet & Gyne

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Diagnosis, transport, and outcome in fetuses with left ventricular outflow tract obstruction

Cited by 105 publications

References 16 publications

Counselling following a diagnosis of congenital heart disease

Counselling following a diagnosis of congenital heart disease

Hypoplastic left heart syndrome

Prenatal screening of congenital heart disease between ethics and cost‐effectiveness. Time for a change in current prenatal ultrasound screening policies?

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