Prenatal diagnosis and treatment planning of congenital heart defects—possibilities and limits

Abstract

The upcoming expansion of fetal cardiac intervention to ameliorate critically progressive fetal lesions intensifies the need to address issues about the adequacy of technological assessment and patient selection as well as the morbidity of those who undergo these procedures.

Efficacy of fetal echocardiography in prenatal diagnosis of congenital heart diseases

“…Prenatal diagnosis can be particularly important in the case of critical CHDs (those that require surgery or catheterization within the first year of life) that may cause hypoxia and lead to severe organ damage or death in the absence of timely intervention. 5,6 Although several risk factors for CHDs have been identified, such as family history, exposure to teratogenic medications, lack of prenatal vitamin and folic acid use, parenteral CHDs and pregestational diabetes, the causes of the majority of CHDs remain unexplained. However the routine use of fetal screening echocardiography in all obstetric population is still controversial.…”

Anaesthesia management for non-cardiac surgery in children with congenital heart disease

“…This frequency is much higher than expected and is still constant regardless of the continuous progression of prenatal diagnosis [2,3]. In addition to the diagnosis, treatments such as surgical procedures [4−7], interventional procedures [8,9], and intensive care medicine [10] have made extraordinary progress in the past several decades.…”

Three-dimensional Sonography in the Assessment of Normal Fetal Anatomy in Late Pregnancy

“…Better understanding of the pathophysiological causal may encourage some researchers to explore new minimally invasive therapeutic options in terms of early pre-and postnatal cardiac palliation. 50 Three-dimensional surface mode enables sculpture-like reconstruction of the abdominal wall and normal umbilical cord insertion. The complete abdominal surface is invisible by conventional 2D technology, unless the abdominal surface is scanned in a survey-like manner, involving serial tomographic sections in sagittal and transverse planes.…”

“…65 Three-dimensional US enables more sophisticated volume measurements of the irregularly shaped organs. 50,51 Lung and hepatic volume normograms have been published, showing that the volume of these organs increases with gestational age and weight. [63][64][65] After upper abdominal circumference, the best prediction of fetal growth restriction is the hepatic volume.…”