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How fetal testing can change the outcome for kids with heart defects

When a heart condition is diagnosed prenatally, caregivers can proactively provide additional testing, delivery planning and counseling that benefits the baby’s health and parents’ piece of mind.

In some cases, it’s even possible to perform fetal therapy on the child before he or she is even born. Boston Children’s Fetal Cardiology Program can try to repair heart valves the size of a pen point in a fetal heart no bigger than a grape; all while the child is still in the mother’s womb.

Fetal or in-utero therapy is a very complex process that brings together cardiologists, obstetricians, anesthesiologists and nurses in a team effort to perform these procedures. In the following video, Wayne Tworetzky, MD, director of Boston Children Fetal Cardiology Program discusses how difficult these procedures can be, not just because of the small size of fetal hearts, but also because of complications that can arise from performing invasive surgery on a fetus when the mother carrying the baby is perfectly healthy.

In-utero heart surgery is an amazing feat of modern medicine, but before doctors ever get to that point a problem needs to be recognized. Ultrasounds are essential in monitoring fetus development in the womb, but they’re not perfect.

Ultrasound
“Virtually all pregnant women who receive pre-natal care will have a fetal ultrasound during the course of their pregnancy, but that doesn’t mean the ultrasound catches everything,” says Tworetzky. “Congenital heart defects such as hypoplastic left heart syndrome or transposition of the great arteries, and others, can be detected by ultrasound, but research shows that about half the time, they’re overlooked.”

Fetal ultrasounds don't always catch potential heart defects.

“With planned and specially managed care before and after delivery of a child with a CHD, caregivers can treat the infant’s heart right from the start,” Tworetzky says. “They can also minimize the risks for future problems.

Download these tips in PDF format for you to print and bring to your ultrasound

During a fetal ultrasound, Tworetzky suggests parents ask the technician and the doctor the following questions concerning the fetal heart:

  • Do you see four chambers in the baby’s heart? (Desired answer is yes)
  • Are there two upper chambers (left and right atria) with valves controlling blood flow into the heart? (Desired answer is yes)
  • Are there two lower chambers (left and right ventricles) with valves controlling blood flow out to the body (aortic) and lungs (pulmonary)? (Desired answer is yes)
  • Do the two valves and vessels (aorta and pulmonary arteries) exit the heart in a crossing fashion? (Desired answer is yes)
  • Are there any large holes between the lower chambers of the heart? (Desired answer is no)
  • Is the baby’s heart normal? (Desired answer is yes)

If the answers to the above are as desired, then almost all serious heart defects, and  > 90% of all heart defects, can be ruled out.

If the ultrasound shows the possibility of a heart defect, parents should immediately make an appointment with a pediatric cardiologist, who will have access to the most advanced and accurate diagnostic tests. “If further testing show signs of a heart defect your caregivers will help you plan appropriately for your baby’s birth,” Tworetzky says. “This way you’ve given clinicians as much time as possible to make the birth, and early treatment, as smooth as possible.”

One treatment option—and it sounds like something out of science fiction—is repairing CHDs on hearts no bigger than a grape while the baby is still in the mother’s womb.

As you might imagine, it’s an incredibly complex and delicate procedure that brings together doctors, surgeons and nurses. These procedures can be difficult, not just because of the small size of fetal hearts, but also because of complications that can arise from performing invasive surgery on a fetus when the mother carrying the baby is perfectly healthy.

And in this interview with NPR, Tworetzky talks about fetal cardiology and we hear from the parents of a Boston Children’s patient who had surgery while she was still in her mother’s womb.

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