11th Annual Fetal Echocardiography Symposium at UCLA

Surgery for CHD: What and Why the Fetal Specialist Should Know

Gary M Satou, MD FASE FAHADirector, Pediatric Echocardiography

Co-Director, Fetal Cardiology Program UCLA Mattel Children’s Hospital

David Geffen School of Medicine at UCLA

A very long list..• Diagnostic accuracy and screening • Correct Diagnosis

• CHD lesions (many) • Counseling and Prognosis

• Surgical Repair • Timing of Surgery

• Non Surgical Intervention

• Survellience • Long Term Outcomes

Surgery for CHD: What and Why the Fetal Specialist Should Know?

11th Annual Fetal Echocardiography Symposium at UCLA

• Simple / Pictures • Fetal / Neonatal • Still no data • 4 CHD lesions (examples)

Surgery for CHD: What and Why the Fetal Specialist Should Know

Outline

Surgery for CHD: What and Why

the Fetal Specialist Should Know

Box 12.2, Chap 12 Optimizing Prenatal Support

of the Mother and Family

• Pulmonary Atresia Intact Septum (PA-IVS)

PAIVS: RVOT/PV

PAIVS: PDA

PAIVS: Angiography

PAIVS: s/p BT shunt

Treatment: PAIVS (s/p BT shunt)

PAIVS: Pulmonary valve perforation/BD

PAIVS: s/p RVOT patch

R. Jonas, Comprehensive Surgical Management of CHD

• Detection/counseling • Well-timed delivery (term) • Cyanotic newborn: Ductal-dependant (PGE infusion) • Treatment: Catheter, Surgery, Transplant • Other: Myocardial Ischemia, RV size and pressure

Surgery for CHD: What and Why the Fetal Specialist Should Know

PAIVS

Hypoplastic Left Heart Syndrome

Hypoplastic Left Heart Syndrome Surgical Repair (stage 1/3):

Norwood Operation

RV-PA shunt BT ShuntNeo Aortic Arch

FontanGlenn Shunt

Surgery for HLHS: Stage 2 & 3

~ 4-6 mo

~ 3-4 yr

• Detection/extensive counseling • Well-timed delivery (term) • Cyanotic newborn: Ductal-dependant (PGE infusion) • Treatment: Surgery - staged approach (over time) • Other: Single ventricle (RV) function, TR, atrial septum

Surgery for CHD: What and Why the Fetal Specialist Should Know

HLHS

Total Anomalous Pulmonary Venous Return

TAPVR

Total Anomalous Pulmonary Venous Return

Total Anomalous Pulmonary Venous ReturnSurgical Repair:

• Detection* and counseling • Very well-timed delivery (crucial, possible C/S in OR) • Cyanotic newborn: NO PGE - not helpful ! • Treatment: Surgery (Immediate*) • Other: Lung disease, recurrent pulmonary vein stenosis

Surgery for CHD: What and Why the Fetal Specialist Should Know

TAPVR

D-Transposition of the Great Arteries

D-Transposition of the Great Arteries

Newborn: Atrial Septum

Balloon Atrial Septostomy

Balloon Atrial Septostomy

Surgical Repair: Arterial Switch Operation

• Detection and counseling • Well-timed delivery (Balloon Atrial Septostomy) • Cyanotic newborn: Ductal-dependant (PGE infusion) • Treatment: Surgery (Arterial Switch Operation) • Other: VSD, coronary artery pattern, other defects

Surgery for CHD: What and Why the Fetal Specialist Should Know

D-Transposition of the Great Arteries

Which one ?

11th Annual Fetal Echocardiography Symposium at UCLASurgery for CHD:

What and Why the Fetal Specialist Should Know

Summary• 4 CHD examples: PAIVS, HLHS, TAPVR, D-TGA • Very complex: Prenatal counseling, Delivery planning, Treatment • Cyanotic lesions: Ductal-dependant (PGE infusion) • Balloon Septostomy, Catheter Intervention, Cardiac Surgery