The child is the center of the family, and the pregnant woman is in the center of care in the family from the day of pregnancy. In our clinical work, we often encounter inquiries about fetal precocious heart disease. Suffering from the lack of scientific knowledge, family members are very conflicted and confused about whether to diagnose a child with precocious heart disease or not.
Today, we will talk about the screening of fetal precocious heart disease, the importance of cardiac ultrasonography, which pregnant women should have cardiac ultrasonography, the best time for examination, and the scientific guidance of fetal precocious heart disease, and other issues of concern.
I. Classic cases
I once encountered two classic examples: a pregnant woman 28 years old, fetal heart ultrasound diagnosis: right atrium, right ventricle enlargement, tricuspid regurgitation of medium amount, family members strongly requested to abort the child pregnant couples do not tolerate, came to consult, I let the ultrasound physician to confirm the presence of tricuspid valve subluxation malformation, confirmed that there is no, recommended that you can have the child. The child has now been born and the ultrasound was repeated at Nanjing Children’s Hospital and there were no heart problems.
Another example is a 39-year-old pregnant woman who is 38 weeks pregnant and has a complete endocardial cushion defect (also called complete atrial septal defect). It is also a senior pregnancy, it is really a night of whiteheads.
Second, the importance of fetal heart ultrasound examination
In recent years, the incidence of fetal cardiovascular malformations has ranked first among birth defects. Fetal cardiac ultrasonography is safe, non-invasive and reproducible, and facilitates the screening and tracking of precocious heart disease. Fetal heart ultrasound can reduce the birth of fetuses with serious and complex malformations, and can also provide timely health education to pregnant women and timely treatment of children born with precocious heart disease to promote eugenics.
Which pregnant women should have fetal heart ultrasound
In principle, it is best to do it for all pregnant women who have the conditions, because precocious heart disease is epidemic and has no clear cause, and is related to genetic and environmental factors.
Fetal ultrasound screening is recommended to be mandatory for the following groups of people: pregnant women older than 35 years old; pregnant women or pregnant women’s family members with precardiac disease; pregnant women with a history of abnormal pregnancy; pregnant women with symptoms such as colds and infections or who have taken medications in early pregnancy; pregnant women with underlying diseases such as diabetes and infectious diseases.
Routine fetal ultrasound screening suspected heart malformation; twins; fetus with cardiac arrhythmia; fetus with chromosomal abnormalities; fetus with other problems such as hydrocephalus and kidney.
IV. Timing of fetal heart ultrasound examination
Mid-pregnancy is the best time for examination, and 20-24 weeks of pregnancy is the most suitable stage.
In early pregnancy, the fetus is too small, and in late pregnancy, the fetal activity is restricted due to the decrease of amniotic fluid, which will affect the examination, but at present, for experienced ultrasonographers in 16-40 weeks of pregnancy can make a diagnosis of fetal precardiac disease.
V. What to do if precocious heart disease is found in fetus
If fetal heart ultrasound reveals: enlarged arterial duct, pulmonary valve stenosis, atrial septal defect, ventricular septal defect, enlarged ventricle or atrium, right-sided heart, permanent left superior vena cava, right aortic arch, etc. Some of these common congenital heart defects have no effect on cardiac function: e.g., right-sided heart, perpetual left superior vena cava, right aortic arch, etc. A significant proportion of simple defects can heal, see the problem of self-healing of congenital heart disease. Even if they do not heal, the treatment is very effective and can achieve a similar quality of life as normal after treatment, so it is recommended to continue the pregnancy, especially in pregnant women of advanced age or those who are not easily pregnant.
If the fetal heart ultrasound diagnosis is: hypoplastic left heart syndrome, single ventricle, pulmonary atresia, tricuspid atresia or inferiorly displaced malformation, severe right ventricular dysplasia, complete endocardial cushion defect (easily combined with Down syndrome at the same time, especially type B and C), corrected transposition of the great arteries, aortic arch dissection, etc. These precardiac diseases have poor outcome and high mortality, and even with surgery, the children do not achieve a normal quality of life, so prompt termination of pregnancy is recommended.
For those in between, such as tetralogy of Fallot, double outlet of the right ventricle, complete transposition of the great arteries, single atrium, triple atrium heart, type A complete endocardial cushion defect, complete or partial ectopic drainage of the pulmonary veins, aortic constriction, etc. To carefully consider, according to their own conditions, if the pregnant woman is young, it is recommended to terminate the pregnancy in time; if it is not easy to conceive or advanced maternal age, you can also consider giving birth to the child and treating the child in time, the long-term results are still possible, but some children may have complications such as cardiac insufficiency, and some need secondary surgery.
VI. Treatment of fetal precocious heart disease
At present, fetal precocious heart disease cannot be effectively treated, and many treatments are still in the experimental stage and have not entered the clinic. However, as research progresses, it is possible that precocious heart disease will be effectively treated in the fetal stage in the future, which will be another breakthrough in clinical medicine.
In conclusion, it is important to raise awareness, pay attention to screening, detect fetal precocious heart disease in a timely manner, consider termination of pregnancy according to the specific situation, and promote eugenics.