G168(P) Antenatal management of fetal cardiac diseases, a single centre experience in egypt

Abstract

Aims The antenatal diagnosis of congenital heart diseases (CHD) is crucial for fetal and perinatal management; however, there is little in literature regarding the pharmacologic intervention for fetal CHD in Egypt. Therefore, we attempted to detect fetal cardiac structural or functional abnormalities using fetal echocardiography and plan fetal pharmacologic intervention without endangering the mother’s life. Methods Cases fulfilled inclusion criteria were diagnosed using detailed fetal Echocardiographic examinations and antenatal treatment was described if indicated after a written consent. Cardiovascular profile score (CVPS) was used to assess the response to treatment. Postnatal transthoracic Echo was done to confirm diagnosis with follow up till the end of neonatal period to determine outcome. Results Fetuses fulfilled inclusion criteria were 143 with a mean gestational age at diagnosis 27.59 ± 5.41 weeks, mean maternal age at diagnosis was 26.64 ± 5.428 years, the most frequent cause of referral was family history of CHD (34.1%). Twenty fetuses (14%) received antenatal therapy. Fetuses with heart failure due to structural cardiac defects (n = 4) and functional non arrhythmic heart failure (n = 8) received digoxin while cases with fetal tachyarrhythmia (n = 6) received digoxin and/or sotalol or flecainide and fetuses with immune mediated fetal heart block (n = 2) received dexamethazone. Success in tachyarrhythmia was statistically significant regarding CVPS (p = 0 .038) and heart rate changes (p = 0 .002) but statistically insignificant regarding CVPS in structural defects ( p = 0 .102) and non-arrhythmic functional heart failure (p = 0 .343). Conclusion Antenatal cardiac pharmacologic intervention is possible with hydrops fetalis reversal in fetal tachyarrhythmia and resolution of first degree immune mediated atrioventricular block. On the contrary, no response to antenatal digoxin use in fetal structural heart failure and limited response in non-arrhythmic functional heart failure.