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Heart Defects: Prenatal Diagnosis In Details

Congenital heart disease is the most frequent pathology of fetal development, which occurs with a frequency of being being diagnosed among 4-8 babies per 1,000 births. Features of congenital heart disease lies in the fact that they can be complex, critical, and their course is characterized by leaps and bounds. Therefore, about 30-40% of children are born with congenital heart dies in the first weeks or months of life, if they are not provided with urgent care.

Heart Defects: Prenatal Diagnosis In Details

Prenatal diagnosis

The most important thing is an early, prenatal diagnosis of CHD, which began to be done around the world more than thirty years ago. Center for Pediatric Cardiology and Cardiac Surgery The Ministry of Health in Ukraine is being engaged in prenatal diagnosis for 10 years. Therefore, doctors working in the Center received a great experience diagnosing abnormalities of the heart during fetal development.

  • What is prenatal diagnosis? How it can help to identify heart defects in the fetus?

Prenatal diagnosis is an ultrasonic diagnostic method safe for the fetus and the pregnant woman. This examines cardiovascular system, heart and great vessels. With the help of ultrasonic device can check all the structures of the heart. There are about 200 heart deffects. The complexity of the ultrasound is to know all the vices and make a correct diagnosis. After all, the diagnosis further forecast depends on it.

Andrew Kurkevich,
Head of polyclinic department in The Ukrainian Ministry of Health,
cardiologist, a specialist in prenatal diagnosis

It is best to perform prenatal diagnosis during 18-20 weeks of gestation. During this period, heart is already well formedand one can see all its structures, so all existing heart defects can be diagnosed at this stage. The procedure is best to be conducted during a period of 18-20 weeks of pregnancy yet because abortion is the least traumatic for women if heart disease is  not compatible with life.

  • At which  period it is reccomended to do ultrasound?

Ultrasound needs to be done during 18-22 weeks of pregnancy. Why it should be done up to 22 week of pregnancy? Officially, according to the ministerial orders and medical indications, up to 22nd week a pregnancy can be interrupted by not operable heart disease, very critical heart malfunction etc.

Andrew Kurkevich,
Head of polyclinic department in The Ukrainian Ministry of Health,
cardiologist, specialist prenatal diagnosis

Today hear disese should never be considered as a sentence

At the Center for Pediatric Cardiology and Cardiac Surgery perinatal diagnosis of CHD is held for more than 1,000 pregnant women annually. More than 300 heart defects are diagnosed each year, from which more than a hundred are critical and require operating in the first hours and days after birth. The vast majority of these operations end successfully with a good prognosis for future life.

  • How many women a year are visiting The Center of Pediatric Cardiology and Cardiac ultrasound with suspected heart disease in the fetus? How often the diagnosis is confirmed?

In a year we spend about 1000 surveys. And about 500 heart defects are dianosed, from which 300 are complex heart defects, and out of these 300, there are 150 critical heart defects that need to be operated in the first hours of life. Such operations are carried out in Kiev, namely in the Center for Pediatric Cardiology and Cardiac Surgery, Heart Institute and the Amosov Institute of Cardiovascular Surgery. 70% of operations for curing the child's heart are conducted in our center. Thus, patients are advised to give birth in Kiev, where our ambulance will be waiting for the child. The uniqueness of the Center for Pediatric Cardiology and Cardiac Surgery is in high-quality diagnosis of the fetus before birth and the possibility of carrying out operations on children's heart in the first hours or days of life.

Today the accuracy of prenatal diagnosis is more than 97%. But, unfortunately, in Ukraine there is a problem with training midwives, ultrasound specialists, who would be able to see fetal malformations during diagnostics and direct pregnant women to a specialized center for further examination. In Ukraine before the birth only 10-12% of heart defects are found. And about 5,000 children a year are born with heart defects.

Andrew Kurkevich,
Head of polyclinic department in The Ukrainian Ministry of Health,
cardiologist, a specialist in prenatal diagnosis

Important information for parents

Parents need to know that in case of any suspicion of a UPU they should conduct a consultation with a highly qualified cardiologist, who is not only able to establish an accurate diagnosis, but also to forecast where the child wiil be born, where one should be operated, and how parents should behave in the future.

Some types of congenital heart disease are very complex, so it is necessary to bive birth near cardiological center. Other UPU cases do not need special monitoring during the birth, and parents can bring their child for consultation later, after one month in particular. There are simple UPU cases, which require only regular monitoring by a cardiologist, and surgical intervention is not necessary during the first years of life.

  • After the confirmation of the diagnosis what should future parents do? What reccomendations can you give to pregnant women?

This problem has already been solved on the level of the state. There was developed a clinical protocol forf pregnancy in case of the diagnosis of heart defects in the fetus. Workers Center of Pediatric Cardiology and Cardiac Surgery developed the protocol in the working group. And it clearly indicates further actions, depending on the degree of a defect (simple, complex or critical one). The so-called algorithm, where the pregnant woman should be redirected to a different type of diangosis. Now the main goal is to familiarize the district and regional obstetricians with the protocol. Children with critical heart disease should be born in Kiev. And the ones with a complex defect should be given birth at a regional perinatal center, where they will receive help from specialists, and provided with resuscitation, etc. Children with a simple defect can be born locally.Most heart defects are operated during the first year of life and the critical ones are corrected in the early days.

Abnormalities of the heart do not always require correction. For example, a bicuspid aortic valve is a heart defect, with which a person can live a life, but there are certain indications for surgery in childhood. Minor anomalies may be solved without surgery, for example, the so-called "heart murmurs". Be sure to confirm all the diagnoses with cardiologist.

Andrwe Kurkevich,
Head of polyclinic department in The Ukrainian Ministry of Health, cardiologist, a specialist in prenatal diagnosis

Why do I need a doctor's referral for consultation in pediatric cardiac surgery center?

More than 20,000 consultations are carried out at the Center for Pediatric Cardiology and Cardiac each year. This is a huge burden not only for professionals but also for diagnostic equipment. Therefore, indications for the implementation of such a highly qualified and high-tech survey should be formed clearly.

Thus, before turning to the Center of Pediatric Cardiology and Cardiac Surgery, you should consult with a specialist in the community and regional expert, who decides on the need to consult at the Center for Children's cardiology and cardiac surgery.

  • Do operated children have a chance for a full life? How often should one be screened after heart surgery?

90% of heart defects are operated radically, that is, that the heart functions in the way a healthy one does.

Some of them have complex heart defects, which are operated radically, but there is a residual pathology. Over time, the child's heart grows, child becomes short of breath and quality of life deteriorates. 25% of these children are undergoing a second operation. However, for these children the door to adulthood has not closed, they just have to pick a less active sports, such as swimming. They are allowed to participate in sports, but without passing PE tests.

Unfortunately, there are 10% of children for whom we can not "make" a healthy heart. This is a difficult group. During childhood they undergo at least 3-4 operations. Doctors inform parents about it. These children must be under constant medical supervision and have to be screened at least once every 6 months.

Andrew Kurkevich,
Head of polyclinic department in The Ukrainian Ministry of Health,
cardiologist, a specialist in prenatal diagnosis

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