At present, there are still many parents and even obstetricians and pediatricians who believe that congenital heart disease is an incurable disease and that even if surgery is performed, there will be sequelae and the body will not get better in the future. Often these misconceptions lead to a large number of fetuses with simple, curable congenital heart disease being strangled in the womb.
The “one-stop treatment” model of prenatal diagnosis → postnatal diagnosis → postnatal pediatric cardiac surgery is internationally recognized as the best treatment model for congenital cardiovascular anomalies. Guangzhou Women’s and Children’s Medical Center is currently following this model, establishing a joint consultation center for pregnant women and their families to discover congenital cardiovascular problems in their fetuses, which is composed of “Obstetrics and Fetal Center – Prenatal Diagnosis Center —- Heart Center”. A rational and scientific consultation is made based on the condition and treatment results. The cardiologist informs the pregnant woman and her family in detail about her condition and prognosis; the prenatal diagnostic center doctor introduces the necessity, advantages and limitations of prenatal diagnosis (amniotic fluid and cord blood puncture); analyzes the results of genetic-related tests; the obstetrician gives advice on the mode, time and place of delivery based on the pregnant woman’s own and fetal factors. The three parties combine the family situation of the pregnant woman to give the most optimal plan, and the pregnant woman and her family make the final decision. According to the disease characteristics, surgical techniques, perioperative treatment and long-term prognosis of different congenital heart diseases, cardiologists will give the following four kinds of recommendations
I. Termination of pregnancy is strongly recommended.
It is mainly for diseases for which no treatment is determined at this stage or the treatment effect is very poor, and termination of pregnancy in such pregnancies should be done sooner rather than later.
1. Abnormalities in genetic-related tests and clearly untreatable pathologies, such as chromosomal diseases and genetic mutations of clear significance
2, combined with serious malformations of multiple organs
3, rapid growth and large amount of pericardial effusion in a short period of time with unclear boundaries, consider malignant cardiac tumors, or cardiac tumors with large areas of basal and myocardial tissues
II. Recommended termination of pregnancy.
It is mainly for diseases that have treatment methods at this stage, but need to undergo multiple surgeries, huge expenses and uncertain long term prognosis.
1.Severe arrhythmias that affect the quality of long-term survival: e.g. congenital III° atrioventricular block
2.Congenital diseases in which anatomical correction cannot be performed to restore the biventricular circulation
3.Left heart dysplasia syndrome
4.Severe valvular lesions
5.Severe pulmonary vascular dysplasia
6.Severe cardiac failure combined with fetal edema
III. Recommended for retention.
Mainly for diseases with definitive treatment at this stage and better long-term prognosis, but need to spend more.
1.Complete transposition of the great arteries
2.Double outlet of right ventricle
3.Pulmonary atresia with well-developed pulmonary vasculature
4.Pulmonary vascular dysplasia with tetralogy of Fallot
5.Complete ectopic pulmonary venous drainage
6.Aortic constriction
7.Complete atrioventricular septal defect
IV. Highly recommended for preservation.
It is mainly for diseases with definite treatment, low cost and good long-term prognosis.
1.Precardiac diseases with low surgical risk and operable cure: such as ventricular septal defect, large atrial septal defect, single atrium, tetralogy of Fallot with well-developed pulmonary vessels, pulmonary valve stenosis
2. Non-malignant arrhythmias: e.g. frequent premature supraventricular contractions
3, functionally normal variant structures: e.g., permanent left superior vena cava, right-position aortic arch
For families who choose to keep the fetus, it is important to follow up well. For fetuses with complicated precardiac disease, it is recommended that they be born in hospitals with experience in medical and surgical treatment of precardiac disease (e.g. Guangzhou Women and Children Medical Center), or be referred to the above-mentioned hospitals quickly after birth, so that the fetuses can receive timely and necessary treatment after birth. For fetuses with simple precocious heart disease, a follow-up schedule and the timing of initial surgery will be given, and regular follow-ups will be made at our “Precocious Heart Disease Specialist Clinic”. With the development of prenatal diagnosis, more and more cases of fetal cardiovascular system abnormalities have been detected in recent years. In addition to the cases found in our hospital, more and more cases are being referred from outside hospitals, which shows that people are paying more attention to this problem, which means that more and more fetuses will be treated effectively, which also reflects the progress of social and humanistic concepts. Standardized prenatal diagnosis can improve the prenatal detection rate and accuracy of fetal precocious heart disease; the development of rational and scientific intervention strategies can reduce the number of births with severe and complicated precocious heart disease, improve the quality of the population and reduce the burden on society; accurate prenatal diagnosis and the involvement of cardiac specialists can advance the diagnosis and rescue time of severe precocious heart disease, improve the efficacy and reduce neonatal mortality.