Cited by 1,275Congenital Heart Disease StudiesCongenital heart defects researchCongenital Anomalies and Fetal Surgery

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Diagnosis and Treatment of Fetal Cardiac Disease: A Scientific Statement From the American Heart Association

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Donofrio, Mary T., Moon-Grady, Anita J., Hornberger, Lisa K., Copel, Joshua A., Sklansky, Mark S., Abuhamad, Alfred, Cuneo, Bettina F., Huhta, James C., Jonas, Richard A., Krishnan, Anita, Lacey, Stephanie, Lee, Wesley, Michelfelder, Erik C., Rempel, Gwen R., Silverman, Norman H., Spray, Thomas L., Strasburger, Janette F., Tworetzky, Wayne, Rychik, Jack·2014·Circulation

DOI 10.1161/01.cir.0000437597.44550.5d

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Abstract

Background—: The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. Methods and Results—: A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin–twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. Conclusions—: Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.

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Authors: Donofrio, M. T., Moon-Grady, A. J., Hornberger, L. K., Copel, J. A., Sklansky, M. S., Abuhamad, A., Cuneo, B. F., Huhta, J. C., Jonas, R. A., Krishnan, A., Lacey, S., Lee, W., Michelfelder, E. C., Rempel, G. R., Silverman, N. H., Spray, T. L., Strasburger, J. F., Tworetzky, W., & Rychik, J.
ORCID: Donofrio, Mary T.
Hornberger, Lisa K.
Copel, Joshua A.
Sklansky, Mark S.
Cuneo, Bettina F.
Huhta, James C.
Jonas, Richard A.
Krishnan, Anita
Lee, Wesley
Michelfelder, Erik C.
Rempel, Gwen R.
Strasburger, Janette F.
Tworetzky, Wayne
Rychik, Jack
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2014-05-27
Volume: 129
Issue: 21
Pages: 2183-2242
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/01.cir.0000437597.44550.5d
OpenAlex: W2007344602
Cited by: 1,275
References: 599
Citations by year: 2026: 117 · 2025: 128 · 2024: 147 · 2023: 151 · 2022: 119 · 2021: 102 · 2020: 124 · 2019: 92 · 2018: 91 · 2017: 75 · 2016: 72 · 2015: 46 · 2014: 8
FWCI: 50.76
Type: journal article
Language: en
Update notices: correction (2014-05-27)
Open access: bronze
doi.org
Locations: Circulation (publishedVersion)
PubMed (publishedVersion)
eScholarship (California Digital Library) (submittedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Congenital Heart Disease Studies
Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Congenital heart defects research
Health Sciences › Medicine › Surgery › Congenital Anomalies and Fetal Surgery
Keywords: congenital heart disease, fetal arrhythmia, fetal echocardiography, fetal MRI, fetal magnetocardiography, fetal electrocardiogram, fetal heart failure, twin-twin transfusion syndrome, delivery planning, prenatal diagnosis, parental counseling, parental depression
MeSH terms: American Heart Association, Female, Heart Defects, Congenital, Heart Diseases, Humans, Pregnancy, Prenatal Diagnosis, United States, Treatment Outcome

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Diagnosis and Treatment of Fetal Cardiac Disease: A Scientific Statement From the American Heart Association

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