Elena Bespalova, Liudmila Keshchian and M. Kurtser
N-Fomisk Clinical Hospital Lapino, Russian Federation
Objective: Prenatal echocardiography is very important for diagnosis CHD, the management of affected fetuses, including parental counseling for the therapeutic options, the planning of the delivery and the postnatal care.
Methods: Multiple B- scan planes, Doppler color flow mapping and pulsed Doppler, 3-4 Dimensional Fetal Echocardiography. Methods of the echocardiographic identification of fetal CHD are: postnatal echocardiography, angiography, surgery, or autopsy.
Results: A total of 1698 fetal echocardiograms were obtained for 2 last years from which 221(13%) fetuses with a prenatal diagnosis of CHD were enrolled. CHD usually are diagnosed during the first echo. 34% of fetal echocardiograms were obtained before 14 weeks of gestation, 54% of fetal echocardiograms between 18- 21 weeks of gestation, 12% of fetal echocardiograms between 22- 38 weeks of gestation. The delivery through natural birth canals had took place at 76%.
Intrauterine fetal death took place about 0,7%( 2 cases).
Neonatal death soon after birth took place in 0,7% (2 cases). There were the preterm neonates with wide ductus arteriosus and neonatal pneumonia.
Fetal evolution of CHD took place at 59% (162 cases).
Fetal arrhythmias were successfully treated before the birth at 1,4% (4 cases).
In most live born infants, complete surgical repair can be achieved.
Surgical repair for 1 year were made in 23 % (51 cases). There were ductus-dependent CHD, radical correction of the coarctation of the Ao, AVC, TF.
Conclusion: Prenatal diagnosis of CHD was associated with improved preoperative clinical status of these infants and must include detailed extra-cardiac and intra-cardiac assessment to predict the risks of surgical treatment. Prenatal diagnosis of CHD may guide the timing and optimal location of delivery. The deliveries of patients with cardiac anomalies should be conducted in a tertiary obstetrics center with cardio vascular surgery department for optimal perinatal management.
Keywords: Prenatal diagnosis, fetal echocardiography, congenital heart diseases, delivery and postnatal care.
Elena Bespalova is 53 years old and she lives in Moscow. She is a professor, Doctor of Medical Sciences, cardiologist and ultrasonic diagnostic, head of department of perinatal cardiology in the Center of Motherhood and childhood. Her field of activity is ultrasound diagnostics of fetal and neonatal congenital heart diseases and arrhythmias, the treatment of organic complex arrhythmias in the fetus, counseling for babies and pregnant women. She has 389 articles, 7 monographs. She is a laureate of national prize “Vocation”.