Prenatal Diagnosis of TAPVC on Monday, Delivery of Tuesday and Cardiac Surgery at Wednesday - A Model of Perinatal Care in 3rd Trimester in Case of Fetal/Neonatal Critical Heart Defect in Tertiary Center.

Abstract

Total anomalous pulmonary venous connection (TAPVC) is a congenital heart defect (CHD), in which all pulmonary veins connect to the systemic veins or to the right atrium/coronary sinus instead of the left atrium. We present a case report of fetus with prenatally diagnosed isolated infracardiac type of TAPVC in 38th week of gestation. In fetal echocardiographic examination performed in the Department of Prenatal Cardiology, the fetus presented lack of visible pulmonary veins connection to left atrium, abnormal venous confluence behind left atrium, additional vein leading from abdominal cavity to mediastinum and abnormal smooth Doppler blood flow in pulmonary confluence. The accurate prenatal diagnosis allowed to deliver the neonate at term, in tertiary center one day after diagnosis, and to perform surgical reposition of pulmonary veins the following day. The neonate was referred home in a good condition after 28 days of hospitalization. This case is a good example of the value of the 3rd trimester echocardiography. Key words: total anomalous pulmonary venous return, prenatal diagnosis, fetal echocardiographyCorresponding author: l.sokolowski90@gmail.com Submitted: 2016Submitted: -06-30, accepted: 2016 INTRODUCTIONTotal anomalous pulmonary venous connection (TAPVC) is a congenital heart defect (CHD), in which all pulmonary veins connect to the systemic veins or to the right atrium/ coronary sinus instead of the left atrium. TAPVC is a relatively rare pathology.

Maximal velocity of fetal pulmonary venous blood flow

“…Haemodynamic changes in the lung veins may occur in utero as early as in the second trimester and could explain re- ports of chronic changes in the lung veins complicating neonatal or postoperative outcome in some heart anomalies [9]. An abnormal pattern may be seen in anomalous pulmonary venous connection or obstructed left atrium and restrictive foramen ovale [10,11]. In the case of fetal critical aortic stenosis, a double reverse pattern in the pulmonary veins is associated with a poor prognosis [12].…”

Fetal echocardiography in the 3rd trimester of pregnancy as an essential element of modern prenatal diagnostics and perinatal care – recommendations of Polish Society of Prenatal Cardiology 2020

“…It makes it possible to detect defects that may have been unnoticed by the fetal echocardiographer in the first and second trimesters. Examples of such defects are as follows: aortic valve stenosis, coarctation of the aorta, perimembranous or muscular ventricular septal defect, and total anomalous pulmonary venous return [18]. • Detection of cardiovascular abnormalities that very rarely occur before the third trimester (for example: premature constriction of ductus arteriosus or foramen ovale in a fetus with normal heart anatomy, increased resistance in the vascular bed of the fetal lungs) [19].…”

Impact of Prenatal and Postnatal Diagnosis on Parents: Psychosocial and Economic Aspects Related to Congenital Heart Defects in Children

“…Therefore, it is crucial to work closely with a team of specialists, including pediatric cardiologists, cardiac surgeons, neonatologists, and other specialists involved in the treatment of heart defects in children. Prognosis can be improved through regular check-ups, monitoring progress, and implementing appropriate therapies [ 7 , 8 ]. In some cases, further surgical interventions or cardiac procedures may be necessary to improve cardiac function [ 9 ].…”