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Post-Natal Cardiac Management of the Fetus with Congenital Heart Disease

  • Marietta Charakida
  • Owen I. MillerEmail author

Abstract

Prenatal detection of congenital heart disease (CHD) has improved over the past decade. Antenatal diagnosis of CHD allows parental counselling regarding fetal intervention, post-natal surgical options, more intensive pregnancy surveillance, delivery planning and immediate post-natal management. Accurate risk stratification can be performed for fetuses with CHD aiming to reduce perinatal and postnatal morbidity and mortality. For the baby with CHD who is likely to need cardiac intervention in the neonatal period, multidisciplinary coordination involving fetal medicine specialists, obstetricians, neonatologists and fetal/paediatric cardiologists is facilitated. In this chapter, the risk stratification for delivery of fetuses with CHD and the long-term considerations about postnatal cardiac management of CHD are discussed.

Keywords

Postnatal management Risk stratification Congenital heart disease Fontan Transposition 

Supplementary material

Video 18.1

Axial view at the level of the four-chamber view which demonstrates a thick atrial septum. On colour there is only a small communication seen at the atrial level. This appearance is suggestive of restriction at the atrial level (MP4 5760 kb)

Video 18.2a

Balloon atrial septostomy. The balloon catheter is advanced from the IVC to the RA and then to the LA, where the balloon is inflated. Once clear of surrounding structures it is withdrawn sharply into the RA, tearing the atrial septum to create a generous interatrial communication. IVC inferion caval vein, RA right atrium, LA left atrium (MOV 502 kb)

Video 18.2b

Balloon atrial septostomy. The balloon catheter is advanced from the IVC to the RA and then to the LA, where the balloon is inflated. Once clear of surrounding structures it is withdrawn sharply into the RA, tearing the atrial septum to create a generous interatrial communication. IVC inferion caval vein, RA right atrium, LA left atrium (MOV 495 kb)

Video 18.3

Transverse sweep from the four-chamber view to the three-vessel view in a fetus with Ebstein’s anomaly. The typical apical displacement of the tricuspid valve is demonstrated and the atrialised portion of the right ventricle can be appreciated. There is no significant tricuspid valve regurgitation in this case. There is forward flow in the pulmonary artery seen. The size of the pulmonary artery is smaller compared to the aorta and this will be indicative of right ventricular outflow obstruction (MP4 4307 kb)

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation TrustLondonUK

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