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

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• 作者：Mathias Nelle (1)
  Luigi Raio (4)
  Mladen Pavlovic (2)
  Thierry Carrel (3)
  Daniel Surbek (4)
  Matthias Meyer-Wittkopf (4)
  
• 关键词：congenital heart disease ; fetal echocardiography ; in utero cardiac palliation ; postnatal intervention ; prenatal diagnosis
• 刊名：World Journal of Pediatrics
• 出版年：2009
• 出版时间：February 2009
• 年：2009
• 卷：5
• 期：1
• 页码：18-22
• 全文大小：213KB
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• 作者单位：Mathias Nelle (1)
  Luigi Raio (4)
  Mladen Pavlovic (2)
  Thierry Carrel (3)
  Daniel Surbek (4)
  Matthias Meyer-Wittkopf (4)
  
  1. Division of Neonatology, University Hospital Berne, Berne, Switzerland
  4. Department of Obstetrics and Gynecology, University Hospital Berne, Berne, Switzerland
  2. Division of Pediatric Cardiology, University Hospital Berne, Berne, Switzerland
  3. Department of Cardiac Surgery, University Hospital Berne, Berne, Switzerland
  

文摘

Background Newborns with hypoplastic left heart syndrome (HLHS) or right heart syndrome or other malformations with a single ventricle physiology and associated hypoplasia of the great arteries continue to be a challenge in terms of survival. The vast majority of these forms of congenital heart defects relate to abnormal morphogenesis during early intrauterine development and can be diagnosed accurately by fetal echocardiography. Early knowledge of these conditions not only permits a better understanding of the progression of these malformations but encourages some researchers to explore new minimally invasive therapeutic options with a view to early pre- and postnatal cardiac palliation. Data sources PubMed database was searched with terms of “congenital heart defects- “fetal echocardiography-and “neonatal cardiac surgery- Results At present, early prenatal detection has been applied for monitoring pregnancy to avoid intrauterine cardiac decompensation. In principle, the majority of congenital heart defects can be diagnosed by prenatal echocardiography and the detection rate is 85%-5% at tertiary perinatal centers. The majority, particularly of complex congenital lesions, show a steadily progressive course including subsequent secondary phenomena such as arrhythmias or myocardial insufficiency. So prenatal treatment of an abnormal fetus is an area of perinatal medicine that is undergoing a very dynamic development. Early postnatal treatment is established for some time, and prenatal intervention or palliation is at its best experimental stage in individual cases. Conclusion 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.