Treatment of a newborn infant with a congenital heart defect that was discovered through fetal echocardiography
||What if the doctors find a heart defect?
Any significant abnormality detected prior to the baby's birth will be followed by the pediatric cardiologist, your obstetrician and a high risk obstetrician (Maternal Fetal Medicine) through the pregnancy. This is to ensure the baby's heart does not go into heart failure and require early intervention. Our goal is to try to deliver as close to the due date as possible and not deliver early unless there is evidence that the baby is not doing well. Significant heart defects may require delivery at a pediatric heart center if surgery in the first week of life is anticipated.
Remember a fetal echo is examining a heart that may be as small as a grape. The images often are not as clear as they will be once the baby is born. Any preliminary diagnosis of a heart defect seen before birth must be confirmed by an echo after the baby is born.
How does prenatal diagnosis help us?
Some right heart defects such as hypoplastic right heart, pulmonary atresia or critical pulmonary stenosis, are so severe that they rely on the ductus arteriosus (fetal structure) to supply blood flow to the pulmonary arteries so the babies are not blue. Some left heart defects, such as hypoplastic left hearts or critical coarctation, rely on the ductus arteriosus to perfuse the aorta and maintain blood pressure. Identification of these and similar heart defects prenatally alerts the physicians that prostaglandins, a medicine to keep the ductus open, should be started after delivery. If a critical heart defect relying on the ductus is not detected prenatally and the ductus closes, the infant may not survive. Prenatal diagnosis allows the delivery of babies with significant and possibly life threatening heart defects to be delivered at a pediatric heart center. This allows the family to prepare for delivery, tour the NICU, meet the heart surgeons if indicated and become more comfortable with what will occur after delivery. This allows both the mother and the newborn to be at the same hospital for delivery, neonatal care and heart surgery.
Pediatric cardiac surgeon Luca A. Vricella, MD with a patient