Utility of fetal echocardiography in postnatal management of infants with prenatally diagnosed congenital heart disease

Berkley, Eliza; Goens, M. Beth; Karr, Sharon S.; Rappaport, Valerie J.

doi:10.1002/pd.2260

Cited by 67 publications

(55 citation statements)

References 11 publications

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“…Models of risk assessment that include stratification of patients and specific postnatal care recommendations have been reported. 571,572 In practice, anticipated postnatal level of care should be assigned by the fetal diagnostic team, with concomitant delivery room and neonatal care recommendations made before delivery. Table 19 summarizes risk-stratified level of care assignment and coordinating action plans based on reported algorithms.…”

Section: Delivery Room and Neonatal Care Planningmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

1,018

543

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Background— The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. Methods and Results— A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin–twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. Conclusions— Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.

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Section: Delivery Room and Neonatal Care Planningmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

1,018

543

View full text Add to dashboard Cite

show abstract

“…However, fetal echocardiography is highly correlative with postnatal and neonatal echocardiographic findings 29 . Selection bias is always a potential concern in using data to establish reference standards, but we used a strict definition of normality and excluded many subjects with minor abnormalities (e.g.…”

Section: Discussionmentioning

confidence: 99%

Fetal echocardiography: z‐score reference ranges for a large patient population

Lee

Riggs

Amula

et al. 2009

Ultrasound in Obstet & Gyne

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“…24 While our results are similar to study done on fetal detailed echocardiography of Berkely et al who stated his results' accuracy about 97% (94.3-99.0%) but he only calculated it postnatally and from this we deduce that the cardiac scanning is of high accuracy which promotes it to be in the routine screening of all cases, but this is in agreement with Randall et al who didn't support the routine use of fetal echocardiography by cardiologists in the second trimester among unselected and low risk population as it is not cost effective. 24,25 …”

Section: Discussionmentioning

confidence: 99%