Fetal echocardiography for planning perinatal and delivery room care of neonates with congenital heart disease.

Fetal echocardiography facilitates the prenatal diagnosis of infants with congenital heart disease (CHD) and through sequential examinations, allows assessment of fetal hemodynamics and cardiovascular status from the time of diagnosis to delivery. Fetal cardiologists have created diagnostic protocols aimed at risk stratifying severity and potential postnatal compromise in fetuses with CHD, and identifying those who may require special intervention at birth or within the first days of life. In this article, we review fetal cardiovascular physiology, the progression of CHD in utero and fetal echocardiographic findings used for risk stratification of newborns with CHD, as well as some of the basic principles of planning for the neonatal resuscitation and initial transitional care of these complex newborns

Fetal echocardiography for planning perinatal and delivery room care of neonates with congenital heart disease.

Fetal echocardiography facilitates the prenatal diagnosis of infants with congenital heart disease (CHD) and through sequential examinations, allows assessment of fetal hemodynamics and cardiovascular status from the time of diagnosis to delivery. Fetal cardiologists have created diagnostic protocols aimed at risk stratifying severity and potential postnatal compromise in fetuses with CHD, and identifying those who may require special intervention at birth or within the first days of life. In this article, we review fetal cardiovascular physiology, the progression of CHD in utero and fetal echocardiographic findings used for risk stratification of newborns with CHD, as well as some of the basic principles of planning for the neonatal resuscitation and initial transitional care of these complex newborns

Extracardiac Doppler indices predict perinatal mortality in fetuses with Ebstein anomaly and tricuspid valve dysplasia

ObjectivesEbstein anomaly and tricuspid valve dysplasia (EA/TVD) carry high perinatal mortality. Past studies have focused on cardiac predictors of mortality; we sought to describe the fetal echo (FE) extracardiac Dopplers in this cohort and determine their association with perinatal mortality.MethodFetuses with EA/TVD at 23 centers from 2005- 2011 were included for retrospective study. Doppler pattern and velocity of the umbilical artery (UA), umbilical vein (UV), ductus venosus (DV), and middle cerebral artery (MCA) were collected. Bivariate and multivariate analyzes were performed. The primary outcome measure was perinatal mortality, defined as fetal demise or neonatal death.ResultsOf 190 cases that met eligibility criteria, alterations were seen in 50% of UA, 16% of UV, 48% of DV, and 8% of MCA Doppler indices on the last FE (median 27.4- weeks). Independent predictors of perinatal mortality included abnormal UA Doppler pattern of absence or reversed end diastolic flow (OR 9.7) and UV velocity z score <1 (OR 2.5), in addition to diagnosis <32- weeks (OR 4.2) and tricuspid valve (TV) annulus z score - ¥6 (OR 5.3).ConclusionAbnormal UA Doppler pattern and decreased UV velocity are independent predictors of perinatal mortality in EA/TVD fetuses and should be used to refine mortality risk and guide perinatal management.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167050/1/pd5873.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167050/2/pd5873_am.pd

The International Prenatal Cardiology Collaboration Group – nowa idea międzynarodowych badań naukowych

Congenital heart defects are among the most common congenital defects and contribute substantially to the mortality of newborns and young infants, in spite of well-developed medical and surgical treatments. It is estimated that the mortality of children with congenital heart defects in developing countries is as high as 20%, whereas the incidence of congenital heart defects is approximately 1/100 live births(1). Currently, there is an emphasis on early fetal screening for chromosomal abnormalities and neural tube defects, despite the fact that congenital heart defects are four times more frequent than chromosomal abnormalities and six times more frequent than neural tube defects(2). It should be noted that basic in-utero screening for heart defects is possible as early as the first trimester, which in some cases prompts further work-up and treatment(3). Throughout the world, second trimester screening remains the mainstay of prenatal diagnosis of cardiac anomalies. However, a comprehensive work-up for fetal heart defects can be associated with substantial psychological burden on the mother and her family. Moreover, the prevalence of misdiagnosis can be as high as 36%, thus prompting the need for further training and multidisciplinary team work(4). Furthermore, 33% of heart defects are accompanied by other anomalies(5).Wrodzone wady serca należą do najczęstszych wad wrodzonych i mimo rozwiniętego leczenia zachowawczego, jak i operacyjnego w dalszym ciągu stanowią jedną z najczęstszych przyczyn zgonów w okresie noworodkowym i wczesnoniemowlęcym. Szacunkowo określa się, że śmiertelność może dotykać około 20% dzieci z wrodzonymi wadami serca w krajach rozwijających się, a każdego roku częstość wrodzonych wad serca oscyluje w granicach 1/100 żywych urodzeń(1). Obecnie uwaga jest kierowana głównie w stronę wczesnej diagnostyki genetycznej, tymczasem wrodzone wady serca są aż 6 razy częstsze od wad chromosomalnych i 4 razy częstsze od wad cewy nerwowej(2). Podstawowa diagnostyka kardiologiczna u płodu jest możliwa już w I trymestrze ciąży i w wybranych przypadkach klinicznych przyczynia się do dalszego postępowania diagnostycznego i terapeutycznego(3). Mimo to w dalszym ciągu podstawowe pozostaje badanie serca płodu w II trymestrze. Kompleksowa diagnoza kardiologiczna płodu niesie ze sobą duże obciążenie psychiczne dla ciężarnej i jej rodziny. Wynika z tego konieczność dalszego szkolenia oraz pracy wielodyscyplinarnej, gdyż – jak pokazują dane z piśmiennictwa – odsetek prenatalnie nieprawidłowo postawionych diagnoz może sięgać nawet 36%(4), a aż 33% wad serca nie jest wadą izolowaną(5)