Impacts of prenatal ultrasound on morbidity and mortality of cardiac pathologies in pediatrics

Résumé 0

Introduction Background The literature describes numerous advantages associated with prenatal diagnosis of congenital heart disease (CHD). The main findings indicate that prenatal diagnosis of CHD is associated with lower morbidity and mortality among newborns, as well as other benefits. For example, it allows the parents to consider termination of pregnancy (TOP), in case of severe disease with poor prognosis, especially when there are associated extracardiac malformations or chromosomal defects(3). Similar cases are handled by a multidisciplinary counseling team when a diagnosis of CHD is found(38). Furthermore, if the parents decide to continue the pregnancy, it allows them to be better prepared to the postnatal life(51). Thus, the stress induced by a perinatal discovery of a cardiac disease can be reduced. Parents can be reassured by the recommendations of the medical staff and the preparation of the early care after birth. The malformations that most likely benefit from a prenatal diagnosis are those threatening the children's life soon after birth, and thus necessitating early treatments. Examples of these defects are ductus arteriosus dependent CHD, cyanotic CHD, severe obstructive CHD (valvular stenosis) and arrhythmia(51). In those instances, it is important to manage perinatal care by determining the time and place of delivery, usually in a tertiary care center. Early treatments should be initiated soon after birth, for example prostaglandins use and mechanical ventilation. Surgery or catheterization can be planned during the same period(3). Moreover, for some defects, it seems that prenatal diagnosis leads to better preoperative conditions, in terms of haemodynamic stability for example(32), and that this could contribute to reduce morbidity and improve neurodevelopmental outcome(62). In few cases, fetus may benefit from a prenatal intervention. For example, we can proceed to a balloon valvuloplasty in case of aortic or pulmonary valve stenosis, but there are limited indications(62).