Fetal heart defects
32% of heart defects are diagnosed as part of prenatal diagnostics.
The spectrum of heart defects diagnosed intrauterine differs from the spectrum of heart defects diagnosed postpartum in that more complex heart defects are diagnosed, which show progression in the course of pregnancy and can be associated with extracardiac malformations and chromosomal anomalies.
However, even complex heart defects do not generally pose a problem for the foetus intrauterine due to the special nature of the foetal circulation - the child is adequately supplied via the placenta - the event of intrauterine foetal death is rare.
In principle, a heart defect is not a contraindication to a normal birth.
In critical heart defects with ductus-dependent perfusion of the pulmonary or systemic circulation, prostaglandin must be administered in the first few hours of life in order to keep the ductus arteriosus botalli open.
However, there are also heart defects that may require very rapid intensive management or a Rashkind procedure postpartum (e.g. transposition of the great arteries).
After the examination, a detailed information discussion is held with the aim of "making the future manageable" for the parents.
The type and severity of the heart defect are essential for the prognosis, possibly also the influence of other genetic programmes (e.g. 22q11).
In addition to possible intervention in the foetus - especially in the case of valve stenosis - the surgical options (biventricular correction or, in the case of a single ventricle, gradual palliation (e.g. aortopulmonary shunts, Glenn operation, Fontan operation) and cardiac catheter interventions (valve dilatation; ductal stents, etc.) or hybrid interventions (e.g. hypoplastic left heart) are discussed.
Questions about the possible effects of the heart defect on everyday life (hospitalisation, medication, school, sport, pregnancy, risk of recurrence) are answered, as are questions about the expected intrauterine course, the type of delivery and the effects of a possible premature birth.
In the regular interdisciplinary perinatological meetings, we determine the treatment plan, including the mode of birth, for each individual child in order to anticipate the postpartum cardiac dynamics and symptoms and, of course, discuss it with the parents.