Diagnosis and Treatment of Fetal Cardiac Disease
Top Cited Papers
- 27 May 2014
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 129 (21), 2183-2242
- https://doi.org/10.1161/01.cir.0000437597.44550.5d
Abstract
Background—: The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. Methods and Results—: A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin–twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. Conclusions—: Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.This publication has 100 references indexed in Scilit:
- Prenatal diagnosis of atrial restriction in hypoplastic left heart syndrome is associated with decreased 2‐year survivalPrenatal Diagnosis, 2012
- Introducing array comparative genomic hybridization into routine prenatal diagnosis practice: a prospective study on over 1000 consecutive clinical casesPrenatal Diagnosis, 2011
- Effect of selective fetoscopic laser photocoagulation therapy for twin–twin transfusion syndrome on pulmonary valve pathology in recipient twinsUltrasound in Obstetrics & Gynecology, 2010
- Metric optimized gating for fetal cardiac MRIMagnetic Resonance in Medicine, 2010
- Assessment of regional right ventricular longitudinal functions in fetus using velocity vector imaging technologyPrenatal Diagnosis, 2010
- Outcome of antenatally diagnosed cardiac rhabdomyoma: case series and a meta‐analysisUltrasound in Obstetrics & Gynecology, 2008
- Nuchal translucency measurement and congenital heart defects: modest association in low‐risk pregnanciesPrenatal Diagnosis, 2007
- Prenatal diagnosis of congenital malformations and parental psychological distress-a prospective longitudinal cohort studyPrenatal Diagnosis, 2006
- Is measurement of nuchal translucency thickness a useful screening tool for heart defects? A study of 16 383 fetusesUltrasound in Obstetrics & Gynecology, 2006
- Partial and total anomalous pulmonary venous connection in the fetus: two‐dimensional and Doppler echocardiographic findingsUltrasound in Obstetrics & Gynecology, 2003