G197(P) Perinatal management of major structural congenital cardiac defects as guided by fetal echocardiography

Aims To assess the perinatal management of critical and major congenital heart defects (CHDs) as guided by fetal echocardiography and identify lesions where a precise postnatal course is difficult to predict. Methods One-year, retrospective cohort study of tertiary foetal cardiac referrals. Foetal cardiology plan was compared to actual neonatal management and variations in antenatal and postnatal diagnosis assessed. Results The study included 149 patients. In 124 (83%) the fetal cardiology plan matched postnatal management. Seven (4.7%) required earlier or unplanned interventions. Retrospectively, prostaglandin was not required in 11 thought to be duct dependent lesions (DDLs), urgent balloon atrial septostomy (BAS) not needed in one thought to have a restrictive septum and six had normal hearts. Of 63 patients predicted to require prostaglandin, 52 (82%) had DDL, with seven (14%) needing a trial off prostaglandin to confirm the diagnosis. Eight of the 11 retrospectively not requiring prostaglandin had a prenatal suspicion of arch obstruction. Four of 86 patients (4.6%) not suspected to have DDL required prostaglandin after birth, two had a plan to assess the need for prostaglandin after delivery. BAS at birth was expected in 5 (50%) of 10 with simple transposition. The procedure was needed at birth in three, delayed in one and not required in one. Three of seven patients with adequate atrial mixing prenatally required BAS within 12 hours of age. Conclusion Fetal echocardiography guides appropriate perinatal management in CHDs. The precision of postnatal plan varies by condition with particular challenges in coarctation of the aorta and transposition of the great arteries.