Integrated prenatal diagnosis and postnatal treatment for congenital heart disease

Abstract

Objective To summarize our early experience of an integrated service providing fetal diagnosis and postnatal treatment for congenital heart disease.Methods From August 2006 to May 2010,a total of 46 pregnant women were diagnosed to have fetal congenital heart disease and chose to have continual pregnancy.Spontaneous delivery or cesarean section was performed in the same hospital.Echocardiography and transcutaneous oxygen saturation monitoring were implemented after birth.The treatment schedule and follow-up program were formulated by the neonatologist,pediatric cardiologist and pediatric cardiac surgeon.Results There were 36 cesarean sections and 10 natural deliveries.A total 47 neonates (male 40,female 7) at the mean gestational age of 38 ± 1.4 weeks were born (mean weight of 3.0 ± 0.44)kg.Prenatal and postnatal diagnosis of the major cardiac malformations was identitical.Prostaglandin E was administrated in 10 neonates with ductus dependent complex congenital heart disease.Twenty-three patients underwent the surgical operation,including 15 cases in the neonatal period.Cardiac intervention included the percutaneous pulmonary valvuloplasty in 4 cases and occluder in 3 cases.There were 14 children waiting for therapy and 2 cases were lost in the follow-up.Among 30 children being treated,21 had normal cardiac structure,7 had mild valve lesions,2 died after operation (6.7％ mortality).Conclusions Integrated pattern of prenatal diagnosis and postnatal treatment is consistent with the current therapeutically trend for congenital heart disease.This pattern needs multidisciplinary cooperation to detect fetal cardiac malformation early,predict fetal changes after birth,to eliminate the urgent need for emergency intervention after birth and to increase the success rate. Key words: Heart disease,congenital; Prenatal diagnosis; Fetus