Functional Aspects of Congenital Heart Disease in Utero (original) (raw)
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Congenital fetal heart disease – course and outcome of pregnancies
Abstract: The aim of the study was to analyze the course and outcome of pregnancies with congenital heart disease of the fetus, diagnosed and terminated at the Institute of gynecology and obstetrics Clinical Center of Serbia over four years. The study included 71 patients, divided into 3 groups according to the fetal outcome. Group 1 had consisted of 9 pregnancies terminated artificially, Group 2 of 48 patients who delivered live fetuses, and Group 3 of 14 pregnancies terminated as fetal intrauterine death. The types congenital heart diseases were categorized as follows: 40 had L-R shunting type, 18 R-L shunting type, 8 coartacion of aorta, and 7 valvular diseases. Intrauterine fetal death occurred in 11 pregnancies in Group 3 after 28 weeks of gestation. In 13 cases karyotypisation were done, because of maternal age or intrauterine growth retardation diagnosed with ultrasound, and 9 of them had genetic disorders. Forty-eight fetuses were born alive. Fourteen died in the first 2-7 days and 12 had successful heart surgery. Twenty-two needed no surgical correction. Ultrasound findings were false negative in 3 cases. The diagnosis of fetal heart disease should be done by fetal echocardiogram, which can be preformed early in the beginning of the pregnancy.
Prospective evaluation from single centre of pregnancy in women with congenital heart disease
International Journal of Cardiology, 2009
Study of outcomes of pregnancy in women with congenital heart disease. The cardiac state during and after pregnancy was analysed in 173 women (mean age 28 years, range 21-41) referred for fetal echocardiography and evaluation of maternal heart during 201 pregnancies. Acyanotic lesions were present in 152 women (100 operated), in 175 pregnancies; cyanotic lesions in 21, all operated, in 26 pregnancies. Eighteen patients in 20 pregnancies (9.9% pregnancies) presented an increased risk due to severe arrhythmias or relevant residual hemodynamic lesions (risk group). Complications related to heart defects occurred in 9/201 (4.5%), pregnancies: in 6/175 (3.4%) pregnancies with acyanotic lesions, in 3/26 (11.5%) with cyanotic lesions and in 9/20 pregnancies of the risk group (45%), with a statistically significant difference with respect to the non-risk group. Two cases had serious tachyarrhythmias, five worsened hemodynamic state or cyanosis, one had hemorrhage post-partum on anticoagulants and one died of a rupture of isthmic aneurysm post-coarctectomy. Prematurity occurred in 19.2% of pregnancies with cyanotic and 5.7% with acyanotic lesions. There were 6/201 recurrences of cardiac anomaly (3%). Patients with uncomplicated heart disease had normal course of pregnancy, while complications due to serious arrhythmias or residual hemodynamical lesions and cyanosis occurred in 4.5% of pregnancies and, mainly in 45% of those with increased risk. Thorough evaluation of the cardiologic risk is mandatory for a correct counseling of women planning pregnancy.
Current opinion in critical care, 2005
Part II of this review gives an overview of the different maternal cardiac problems during pregnancy and their management, and developments over recent years. Many studies published over the last 5 years provided new insights on different cardiac diseases in pregnancy. Publications discussed in this part of the review on cardiac disease in pregnancy, for example, provide epidemiological data on heart disease during pregnancy in general, and cardiomyopathy and ischemic heart disease in particular. In addition, we discussed the implications of a history of peripartum cardiomyopathy for a subsequent pregnancy, interventional strategies during pregnancy in women with ischemic heart disease, and the role of echocardiography in the evaluation of cardiac disease in pregnancy. The prevalence of the different causes of heart disease has shifted towards congenital heart disease by the end of the millennium. In developing countries, relatively rare diseases like rheumatic fever are still commo...
Pregnancy: Maternal and Fetal Heart Disease
Current Problems in Cardiology, 2007
Cardiac disorders complicate less than 1% of all pregnancies. Physiologic changes in pregnancy may mimic heart disease. In order to differentiate these adaptations from pathologic conditions, an in-depth knowledge of cardiovascular physiology is mandatory. A comprehensive history, physical examination, electrocardiogram, chest radiograph, and echocardiogram are sufficient in most cases to confirm the diagnosis. Care of women with cardiac disease begins with preconception counseling. Severe lesions should be taken care of prior to contemplating pregnancy. Management principles for pregnant women are similar to those for the non-pregnant state. A team approach comprised of a maternal fetal medicine specialist, cardiologist, neonatologist, and anesthesiologist is essential to assure optimal outcome for both the mother and the fetus.
Evolução e prognóstico materno-fetal da cirurgia cardíaca durante a gravidez
Arquivos Brasileiros de Cardiologia, 2009
Background: Cardiac surgery improves the maternal prognosis in cases refractory to medical therapy. However, it is associated with risks to the fetus when performed during pregnancy. Objectives: To analyze maternal-fetal outcome and prognosis related to cardiac surgery performed during pregnancy and puerperium. Methods: The outcome of 4 gestations of women undergoing cardiac surgery during pregnancy and puerperium was studied. Fetal cardiotocography was performed throughout the procedure in patients with gestational age above 20 weeks. Results: Mean maternal age was 27.8 ± 7.6 years; there was a predominance of patients with rheumatic valve disease (87.8%), of whom 5 (4.6%) underwent reoperation due to prosthetic valve dysfunction. Mean extracorporeal circulation time was 87.4± 43.6min and hypothermia was used in 27 (67.5%) cases. Thirteen (3.7%) mothers experienced no events and gave birth to live healthy newborns. Postoperative outcome of the remaining 28 (68.3%) pregnancies showed: 7 (4.5%) maternal complications and three (7.3%) deaths; 2 (29.2%) fetal losses, and four (0%) cases of neurological malformation, two of which progressed to late death. One patient was lost to follow-up after surgery. Nine (2.9%) patients underwent emergency surgery, and this variable was correlated with maternal prognosis (p<0.00). Conclusion: Cardiac surgery during pregnancy allowed survival of 92.7% of the mothers, and 56.0% of the patients who presented cardiac complications refractory to medical therapy gave birth to healthy children. Worse maternal prognosis was correlated with emergency surgery. (Arq Bras Cardiol 2009;93
Peculiarities of Prevalence and Morphology of Congenital Heart Disease Detected In Utero
Cardiovascular Pathology, 1998
Intrauterine echocardiography is changing our knowledge of congenital heart disease; cardiac defects diagnosed in utero have distinctive features of both prevalence and morphology when compared with those observed just after birth. We reviewed a series of 171 fetal heart conditions: 148 were diagnosed at intrauterine echocardiography, the diagnosis being verified at autopsy in 41, and 23 were observed at the postmortem only. Peculiarities of prevalence consisted in an excess of various defects, such as hypoplastic left heart syndrome, atrial isomerism, pulmonary atresia, and atrioventricular and atrial septal defects, and in a reduced number of completely different conditions, such as transposition of great arteries and aortic coarctation. Differences in prevalence have been attributed to difficulties in diagnosing some particular anomalies in utero, to the selection of pregnancies undergoing screening, and to the special intrauterine evidence of some heart defects. Peculiarities in morphology result from the coexistence with extracardiac malformations, from the changes in shape conditioned by fetal hemodynamics, and from the intrauterine evolution of the morphology of some malformations. We concluded that the knowledge of these characteristic traits was helpful to cardiac pathologists, pediatric cardiologists, and obstetricians, and allowed the reevaluation of the role of hemodynamic factors in remodeling the malformed cardiovascular apparatus.
2017
Antenatal diagnosis of structural CHD is now established in clinical practice in many countries. As a consequence, fetal cardiology has developed into a specialty on its own right. Extra-cardiac, chromosomal and genetic abnormalities are not uncommon associations, and therefore, a multidisciplinary approach is important when counselling families about diagnosis and prognosis of fetal CHD. Complex structural abnormalities can be accurately diagnosed in mid-gestation, and in many instances, this can be accomplished in the first and early second trimester of pregnancy. However, some forms of structural heart disease can progress as pregnancy advances and changes in the perinatal circulation can further modify the neonatal ultrasound findings. All these aspects need to be taken into account when informing parents about diagnosis of fetal heart disease, management plan for the pregnancy, surgical options for the neonate and child but also going into adulthood as well as a balanced accoun...
Echocardiographic evaluation of dilated cardiomyopathy in the human fetus
The American Journal of Cardiology, 1989
The diagnosis of dilated cardiomyopathy was established and subsequently confirmed in 6 of 625 fetuses studied by echocardiography. All 6 had structurally normal hearts. Abnormal findings included reduced fractional shortening index in 5, atrioventricular valve regurgitation in 3, abnormal chamber dimensions in 3 and nonimmune hydrops in 4. In 2 fetuses referred because of a family history of dilated cardiomyopathy in previous siblings, echocardiographic abnormalities were absent on a first examination performed at 20 weeks of gestation. This suggested that a normal fetal echocardiogram in a midtrimester fetus does not always rule out the subsequent development of dilated cardiomyopathy. However, all fetuses followed serially developed some abnormality later in pregnancy. Only 2 neonates survived, 1 of whom required a heart transplant during infancy. Death from cardiac failure occurred in 1 fetus and 3 neonates. This study demonstrates that dilated cardiomyopathy may develop during fetal life and might be diagnosed by echocardiography if serial studies are performed. Dilated cardiomyopathy presenting prenatally appears to have a poor prognosis.
Congenital Heart Diseases in Pregnancy
Bioscientia Medicina : Journal of Biomedicine and Translational Research
This research aims to shed light into congenital heart diseases, the pathophysiology, and the ultrasonographic findings of congenital heart diseases. Congenital heart diseases are a major health concern, affecting 1.35 million children born every year. Ventricular septal defect, atrial septal defect, and atrioventricular septal defect are found in 57.9% cases of congenital heart diseases. The risk factors include consanguineous marriage, family history of congenital heart diseases, old maternal and paternal age, and exposure to teratogens, and genetic factors. Missteps in cardiac development are the main pathophysiology of congenital heart diseases. Ultrasonography screening in 18–22 weeks gestational age is utilized to screen. Follow-up screening can increase detection rate to 80%. This study has limitation of only discussing most common congenital heart diseases and did not delve into rarer types of congenital heart diseases and did not discuss impacts or burden of congenital hear...