FETAL CARDIAC SCREENING IN PROTECTION FROM PERINATAL MORTALITY AND MORBIDITY – THE NEW, VERY IMPORTANT ROLE OF FETAL ECHOCARDIOGRAPHY IN OBSTETRICS AND PEDIATRIC CARDIOLOGY

Abstract

Cilj: Osnovni je cilj ovog pregleda istaknuti vrijednost fetalnog kardiološkog probira (FKP) u zaštiti perinatalnog morbiditeta i mortaliteta uzevši u obzir suvremene dijagnostičke i terapijske mogućnosti i nova znanstvena otkrića. Istaknute su indikacije za FKP prema stupnju rizika, kako tablično tako i u opsežnoj raspravi koja uvažava timski rad i interpretira nalaz uzimanjem u obzir klasičnih smjernica stručnih društava (engl. Classical of recommendations - COR) i rasprave o bolesniku zasnovane na dokazima (engl. Level of evidence - LOE). Metode i rezultati izvedeni su proučavanjem smjernica stručnih društava za fetalnu pedijatrijsku kardiologiju: American Heart Association – AHA, Asociation of European Pediatric Cardiology – AEPC), International Society of Ultrasound in Obstetrics and Ginecology – ISOUG) te druge opsežne novije literature. Ističu se interesi fetalne kardiološke medicine uključujući dijagnozu prirođenih srčanih bolesti i aritmija, procjenu funkcije fetalnog kardiovaskularnog sustava (KVS) i raspoložive metode intrauterinog liječenja, kao i moguću potrebu neposredne ili vrlo rane intervencije nakon porođaja. Opsežnom raspravom uz brojne literaturne citate i tabličnim prikazom istaknute su referalne indikacije za FKP, čimbenici koji povećavaju rizik od prirođenih srčanih grješaka (PSG) i drugih srčanih bolesti (aritmije i kardiomiopatije) te populacijski pregled ekstrakardijalnih anomalija (EKA) koje imaju visok posljedični rizik za pridruženu srčanu bolest. Tekstu je uz tablice priloženo nekoliko važnih crteža ili ehokardiografskih prikaza koji na svoj način prožimaju zajedničke nalaze opstetričara i pedijatrijskog kardiologa-fetologa. Na kraju su istaknuta istraživanja koja dokazuju kako primjena i uvažavanje fetalnog kardiološkog probira pozitivno utječe na smanjenje perinatalnog morbiditeta i mortaliteta, posebno na primjeru složenih PSG. Zaključak: U posljednjih 20 godina fetalna kardiološka medicina je tako uznapredovala u dijagnostičkom i terapijskom smislu da značajno utječe na ukupni perinatalni morbiditet i mortalitet, osobito stoga što su PSG najčešće kongenitalne anomalije. Precizna kardiološka fetalna dijagnostika, sve brojniji terapijski pristupi u fetalno srce, kako medikamentni tako i intervencijski te dinamičan razvoj novih tehnologija doveli su fetalnu kardiološku medicinu do razine bez koje se više ne može zamisliti suvremena medicina u jednoj zemlji.Objective: The main objective of this review is to highlight the value of fetal cardiac screening in the protection from perinatal morbidity and mortality by respecting modern scientifi c, diagnostic and therapeutic possibilities. Indications for fetal cardiac screening according to the level of risk are highlighted, both tabularly and in an extensive discussion that takes into account teamwork and interprets fi ndings by taking into account Class of Recommendation (COR) and evidence-based patient discussions, Level of Evidence (LOE). Methods and results are derived from studying the guidelines of the American Heart Association (AHA), Association of European Pediatric Cardiology (AEPC), International Society of Ultrasound in Obstetrics and Gynecology (ISOUG), and other extensive recent literature. The aim is to highlight the interests of fetal cardiac medicine, including the diagnosis of congenital heart disease (CHD) and arrhythmias, assessment of fetal cardiovascular function and available methods of intrauterine treatment, as well as of immediate or early postnatal intervention. Extensive discussion with numerous literature citations and tabular presentation highlights the referral indications for fetal cardiac screening (FCS), factors that increase the risk of CHD and other heart diseases (arrhythmias and cardiomyopathies), and a population overview of extracardiac abnormalities associated with heart diseases. Along with the inevitable tables, the text is accompanied by several important drawings or echocardiographic representations that in their own way permeate the joint fi ndings of obstetricians and pediatric cardiologists-fetologists. Research confi rming that the application and consideration of fetal cardiac screening has a positive effect on reducing perinatal morbidity and mortality, especially in the case of complex heart defects, is presented at the end. Conclusion: In the last 20 years, fetal cardiac medicine has advanced so much in diagnostic and therapeutic terms that it signifi cantly affects overall perinatal morbidity and mortality, especially because CHDs are the most common congenital anomalies. Accurate cardiac fetal diagnosis, increasing therapeutic approaches to the fetal heart, both medical and interventional, and dynamic development of new technologies have brought fetal cardiac medicine to a level without which modern medicine in any country can no longer be imagined