Fetal and neonatal diagnosis and management in a case of a neonate with congenital heart disease – case report

M.A. Răcean, M. Cucerea, C. Mărginean, L. Gozar

Rezumat: Congenital heart disease (CHD) is the most common form of congenital anomaly. In the fetus, the ductus arteriosus (DA) diverts the deoxygenated blood from the pulmonary artery into the descending aorta. Most fetuses affected by CHD do not exhibit signs of heart failure in utero, as nutrition and oxygen are provided to the fetus by the placental circulation. Upon birth and after the DA closure, a critical coarctation of the aorta (CoA) will cause an increase in left ventricular afterload, with severe cardiac failure and poor perfusion of the lower body. We present the case of a large-for-gestational-age male neonate, born at 39 weeks of gestational age, who had the first fetal diagnosis of congenital heart disease made by the pediatric cardiologist specialized in fetal and neonatal CHD, at 32 weeks of gestational age. The final fetal diagnosis was CoA with hypoplastic arch, and hypoplastic left ventricle, with the recommendations of immediate postnatal reassessment and postnatal prostaglandin E1 (PGE1) infusion. The postnatal echocardiography evaluation performed immediately after birth confirmed the fetal diagnoses. Both fetal and neonatal echocardiography needed to make a definitive diagnosis of the CHD and to guide the management strategies. The initial management of the neonate included intrauterine referring of the mother to a tertiary care center with pediatric cardiology services, hemodynamic stabilization of the neonate, intravenous access, and the initiation of continuous infusion of PGE1. After two weeks, the neonate benefited from surgical treatment and, later, the patient was managed at home, receiving treatment with angiotensin- converting enzyme inhibitor, spironolactone and antiplatelet agents under hepatoprotection. The detection of critical CHD in the prenatal period by fetal echocardiography favors the early postnatal diagnosis and the initiation of adequate treatment. The correlation between the prenatal and the postnatal diagnosis of CHD, along with the prompt initiation of treatment may reduce the morbidity and mortality of the neonates affected by congenital heart disease.
Cuvinte cheie: neonate, congenital heart disease, hypoplastic borderline left ventricle, coarctation of the aorta, prostaglandin E1.