11th Annual Fetal Echocardiography Symposium at UCLA Surgery for CHD: What and Why the Fetal Specialist Should Know Gary M Satou, MD FASE FAHA Director, Pediatric Echocardiography Co-Director, Fetal Cardiology Program UCLA Mattel Children’s Hospital David Geffen School of Medicine at UCLA
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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
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