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

Abstract

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.

Prenatally diagnosed foramen ovale restriction in fetuses with hypoplastic left heart syndrome may be a predictor of longer hospitalization, but not of a need for an urgent rashkind procedure

“…Pruetz from Los Angeles divided patients with CHD into four classification groups with regard to the varying needs for emergency neonatal cardiac intervention (ENCI) [9]. According to his classifications, all cases of HLHS belong to the ENCI 3 group, which is characterized by the need for intravenous infusion of prostaglandin E1 and the possible need of urgent cardiac intervention [3,4,9]. The CHD classifications created by Respondek-Liberska and Slodki take into account the fact that fetuses and newborns with HLHS are not a homogeneous group of patients, and that instead, their hemodynamic state differs during the 3rd trimester of pregnancy, depending on the patency and size of the prenatally assessed foramen ovale [5,7,8].…”

“…The CHD classifications created by Respondek-Liberska and Slodki take into account the fact that fetuses and newborns with HLHS are not a homogeneous group of patients, and that instead, their hemodynamic state differs during the 3rd trimester of pregnancy, depending on the patency and size of the prenatally assessed foramen ovale [5,7,8]. Donofrio et al from Washington reached the same conclusion and divided patients with HLHS into three groups which they called "Levels of Care" (LOC) groups [3]. In their classification, HLHS newborns with prenatally diagnosed non-restricted FO were assigned to LOC 2.…”

“…The ultrasound criterion for inclusion in this group was a VTI f/r ratio in pulmonary veins blood flow spectra of < 3. The prognosis in such newborns is the most severe and in the Washington center the Rashkind procedure was performed in the first minute after birth in the delivery room [3,4,11]. Polish delivery rooms do not allow the performance of such necessary operations due to a lack of adequate facilities.…”

“…Patient management for HLHS in the fetus depends on the fetal hemodynamic status in the 3rd trimester of pregnancy. New classifications for CHDs primarily categorize HLHS according to the anticipated postnatal status of the newborn and on the assessed urgency for treatment [3][4][5]. As such, individual HLHS cases are assigned to one of the following three groups: Ū severe planned HLHS: HLHS does not require urgent postnatal treatment -the newborn is born in good condition and requires only prostaglandin E1 iv infusion, and can be prepared for the first stage of planned cardiac surgery Ū severe urgent HLHS: HLHS requires, in addition to prostaglandin E1 iv infusion, urgent (first 24 hours) treatment in a catheterization laboratory (cath lab) Ū severest HLHS: HLHS during the first minutes of postnatal life is cyanotic, does not respond to iv prostaglandin E1 infusion, and is deteriorating within minutes or within the next few hours.…”

Introduction: From fetal echocardiography to fetal cardiology: A journey of over half a century

“…In the sixth article, Sanapo et al review fetal cardiovascular physiology, the progression of congenital heart disease in utero, and fetal echocardiographic findings used for risk stratification of newborns with congenital heart diseases, as well as some of the basic principles of planning for the neonatal resuscitation and initial transitional care of these complex newborns. They discuss risk stratification systems of low‐, minimal‐, and high‐risk congenital heart disease.…”