Prenatal Diagnosis and Treatment of Congenital Heart Disease

Ajax Aetos^*

Department of Gynecology, National and Kapodistrian University of Athens

Abstract

Heart defects are the most common type of congenital malformation, and they are linked to a high rate of perinatal, long-term, and comorbidity and mortality. This update aimed to review the rate of prenatal detection, screening characteristics throughout the pregnancy, indications for advanced echocardiography, and a management algorithm in the event of a prenatal diagnosis of a congenital heart disease. Potential intrusive and painless tests and obstetric subsequent will be talked about here. The main features of fetal therapy for heart anomalies, including cardiac interventions and intrauterine treatment of arrhythmias, will be reviewed at the conclusion.

Heart defects are the most common type of congenital malformation, and they are linked to a high rate of perinatal, long-term, and comorbidity and mortality. This update aimed to review the rate of prenatal detection, screening characteristics throughout the pregnancy, indications for advanced echocardiography, and a management algorithm in the event of a prenatal diagnosis of a congenital heart disease. Potential intrusive and painless tests and obstetric subsequent will be talked about here. The main features of fetal therapy for heart anomalies, including cardiac interventions and intrauterine treatment of arrhythmias, will be reviewed at the conclusion.

Keywords

Congenital malformation• Prenatal diagnosis•, Cardiac intervention• Arrhythmias • Prenatal detection

Introduction

Heart conditions, which are the most normal kind of inborn mal formation, occur in 1 % o fbabies and are related with a high perinatal dreariness furthermore, mortality. A tertiary care facility capable of providing neonatal diagnosis and management (through therapeutic catheterization and/or cardiovascular surgery), which has shown to reduce associated perinatal morbidity and mortality, can be referred to a pregnant woman with a complex Congenital Heart Disease (CHD) in order to provide the family with guidance on the prognosis, plan an adequate obstetric follow-up, offer intrauterine medication, especially in selected cases [1,2].

Timing of assess fetal heart

Between weeks 20 and 24, a routine, in-depth fetal ultrasound is used to evaluate the heart of the fetus. As of now, this test has been normalized by the Worldwide Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and comprises in a screening technique including the fourchamber view, ventricular surge lot view, and three-vessel and three-vessel also, windpipe sees . Moreover, a fetal echocardiogram is demonstrated in patients at a higher gamble for CHD looked at to everybody . Diabetes mellitus is one of the most common conditions in mothers, putting them at risk for malformations two to three times more than the general population. Glycosylated hemoglobin levels are associated with this increased risk: A higher level of glycosylated hemoglobin increases the likelihood of birth defects. In connection to CHD, there is a higher gamble for primary contortion due to a modified embryogenesis, possibly clear in early tests, 8 and for septal hypertrophy and hypertrophic cardiomyopathy because of hyperinsulinism, which can be confirmed in the third trimester [3, 4]. CHD may likewise be the consequence of early stage openness to a large number of synthetic compounds. In connection to sporting medications, liquor is the most predominant specialist. Lithium, isotretinoin, misoprostol, and some anticonvulsant medications like phenobarbital and valproic acid are associated with CHD. A positive family history of CHD is also known to be a risk factor [5]. After having a child with heart disease, there is a risk of recurrence that ranges from 2% to 5%. This risk varies widely depending on the type of heart disease, and it is even higher when there are more than one child with heart disease. When one of the parents has CHD, the risks are also higher, and the mother has a higher risk of recurrence (10-15%) than the father does [6, 7].

Therapy

Fetal Tachyarrhythmia

Generally speaking, the strategy that has a better chance of survival is one that tries to reverse arrhythmia in utero; to this end, since this strategy may be undeniably challenging, it is essential to follow severe the board conventions. The most generally utilized antiarrhythmic specialists incorporate digoxin, flecainide, and sotalol and, less significantly, amiodarone, and they might be utilized alone or in mix (particularly on account of embryos with hydrops). Because all antiarrhythmic medications have the potential to cause arrhythmias, it is essential to perform a thorough cardiac evaluation and monitor the mother’s heart rate. Although the case of a fetus with refractory hydrops receiving an intrauterine pacemaker has recently been reported 49, the procedure is still in its infancy [8].

Fetal bradyarrhythmias

A heart rate that consistently falls below 100- 110 beats per minute is what distinguishes these. Whether a fetus has structural heart disease or not, bradyarrhythmias in the fetus can occur. Anti- Ro (anti-SSA) and Anti-La (anti-SSB) antibodies must be measured in the mother in people without structural heart disease. Because transplacental transfer can damage the conduction system and affect myocardial function due to fibroelastosis, the risk of complete atrioventricular block is 1-2 percent in people without a family history and 15-20 percent in people with a previous affected child. In the event of a prolonged mechanical PR interval (first- or second-degree block) or the presence of fibroelastosis50, the administration of corticosteroids to the mother, whether or not they are associated with sympathomimetic medications, has been associated with potential benefits, but data are insufficient [9,10].

Conclusion

Regardless of the significance of pre-birth conclusion of CHD, the pace of identification is still low in the all inclusive community. This mirrors the constraints of pre-birth finding and warrants any work made to further develop information around here for the reason of improving perinatal results in kids with CHD.

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