HEAVEN CAN WAIT

A NEW VISION &ORIENTATION IN PERINATAL CARDIOLOGY

INTERNATIONAL PROJECT

Prof. Maurice GUIRGISFETAL & PEDIATRIC CARDIOLOGY UNIT

Hôpital Bichat– University Paris VII

INITIAL VISION IN FETAL CARDIOLOGY

VERS UNE CARDIOLOGIE PRENATALE

« THE FETUS AS CARDIAC PATIENT » Jean Kachaner & Laurent Fermont

Presse Médicale 1984

ACTUAL ORIENTATION /TRENDS IN FETAL CARDIOLOGY IN EUROPE

EARLY DIAGNOSIS++/GENETIC & EXTRACARDIAC ANALYSIS

INCREASE PRENATAL DIAGNOSIS

TOP/ DECREASE PREVALENCE OF CHD

TT OF FETAL ARRHYTHMIAS

PRENATAL CATH ….

DECREASE IN MORBIDITY & MORTALITY OF CHD

ZOOM ON ACTUAL ORIENTATION

• EARLY DIAGNOSIS :

• PITFALLS 1st >2nd

Trim

• Fetal heart defects

:Potential and pitfalls of

first trimester detection • A Khalil & K. Nicolaides Sem in

Fetal and Neonatal Med 2013

ZOOM ON ACTUAL ORIENTATION

• VERY EARLY

DIAGNOSIS :• NO ACCURATE PROGNOSIS

POSSIBLE IN BORDERLINE

CASES: LACK OF STUDY OF

EVOLUTIVITY POTENTIAL

-> TOP

ZOOM ON ACTUAL ORIENTATION NO TIME TO STUDY EVOLUTION

TOP

ZOOM ON ACTUAL ORIENTATION

• CARDIAC ANOMALY AS

SIGN OF GENETIC DIS.

• WHATEVER IS THE TERM OR

EVEN IN CASE OF

DOUBTFULL DIAGNOSIS AS

« PRINCIPE DE

PRECAUTION »

PSYCHIC PRESSURE

FAMILY ANXIETY

ZOOM ON ACTUAL ORIENTATION

• CARDIAC ANOMALY AS

SIGN OF GENETIC DIS.

• LINEAR INSERTION OF

AV VALVES

PRESSURE ON

CARDIOLOGISTS

ZOOM ON ACTUAL ORIENTATIONIMPACT ON PREVALENCE OF CHD

RECENT DECREASE IN THE PREVALENCE OF CHD IN EUROPE

B KOSHNOOD et al J Pediatr 2013;162:108-13

1990-2007 : 47508 cases with no Chrom Anomalies16 countries 19 Population Europ Registries EUROCAT

DECREASE PREVALENCE BY 4% PER YEAR BETWEEN 2004-2007

GROUP 1 : INCREASE IN PRENATAL DIAGNOSIS AND TOP

IMPACT ON PREVALENCE, TIMING OF DIAGNOSIS AND MORTALITY OF NEWBORNS WITH CHD

EPICARD 2005-2008 B KOSHNOOD et al HEART 2012; 98:1667-73

HETEROTAXY 89,2%/ UNIVENTRICULAR HEART 92,5%

ZOOM ON ACTUAL SITUATION ON FETAL & PERINATAL CARDIOLOGY FOR CRITICAL HD AND

OUTCOME IN DEVELOPING COUNTRIES

NO OR TREVIAL PRENATAL PROGRAM IN DEVELOPING COUNTRIES

(BUT GROWING ATTEMPTS )

OPTIONS AFTER PRENATAL DIAG CRITICAL HT -TOP

-DELIVERY NEONATAL MANAGEMENT ?/ DEATH

-DEATH BEFORE TIME TO CONTACT ANY HUMANITARIAN ASSOCIATION

-DEATH WAITING INTERVENTION

-LACK OF CHANCE FOR OPTIMAL SURGERY : SENNING VERSUS SWITCH FOR SIMPLE TGV

CONTRASTING SITUATIONSEUROPE : HIGH DETECTION , HIGH SELECTION AIMING TO PERFECT BABYDEVELOPPING COUNTRIES : HOPELESS SITUATION

TIME FOR CHANGE?

ADDING A NEW DIMENSION FOR FETAL AND PERINATAL CARDIOLOGY ?

HEAVEN CAN WAITTHE STORY

HEAVEN CAN WAITTHE STORY

FEBRUARY 2008 TEACHNING COURSE FETAL

HEART FOR OBSTETRICIANS & RADIOLOGISTS IN MAURITUS

HEAVEN CAN WAIT

3 MONTHS LATER

33 WG FETAL AHT FOR ADVICE: BAD IMAGE QUALITY : DECISION TO COLLECT SOME MONEY FOR FLIGHT TO PARIS FOR EVALUATION

35 WG ARRIVAL TO PARISCONFIRMATION OF AO COARC WITH TUBULAR ARCH HYPOPLASIA

LADY REFUSE STAYING FOR DELIVERY but labour contractions while confirming her flight back to paris

37 WG DELIVERY IN PARIS /SURGERY IN D4 → EXCELLENT RESULT

TRAVEL BACK SAFELY

OBSTETRICIAN LETTER TO THE EDITOR « HEAVEN CAN WAIT »

HEAVEN CAN WAIT EMBRYO OF PROJECT

OBJECTIVES

(1) FETO MATERNAL TRANSFER FOR DELIVERY AND CARDIAC SURGERY IN CRITICAL HD

SIMPLE TGA / COARCTATIONBEST CHANCE FOR NEONATE

(2) OTHER PRENATAL DETECTED CASES :TRANSFER FILE TO HUMANITARIAN

CHAINS FOR WAITING LIST FOR POSTNATAL MANAGEMENT

HOPE FOR THE FAMILY

BETTER MANAGEMENT FOR THE CHAIN

HEAVEN CAN WAIT MEANS

(1) PRENATAL CARDIAC PROGRAM DEVELOPMENT /TEACHING MISSIONS

- Collaboration WHO, Ministry of Cooperation CE,..

- Countries were allready local contact exists with humanitarian associations (Chain of hope , Terre des Hommes , Chaine de l’espoir..)

(2) INTERNATIONAL MULTIDISCIPLENARY TEAM FOR CASE SELECTION : OBSTETRICIAN

/PEDIATRIC CARDIOLOGISTS /NEONATOLOGISTS SURGEONS

(3) TELEMEDECINE (STIC)

FETO MATERNAL TRANSFER

BENEFIT

- LESS EXPENSIVE ?

- MATERNO FETAL > NEONATAL TRANSORT

- NO PSYCHIC TRAUMA (MOTHER /BABY SEPARATION

- BEST CHANCE FOR BABY : OPTIMAL STABILISATION PRENATAL DETECTION OF TGA DECREASE MORBIDITY & MORTALITY

Bonnet et al Circ 1999:916-18

FETO MATERNAL TRANSFER

CONTRAINDICATIONS

• MATERNAL• PLACENT PRAEVIA

• RISK OF PMD

• UNSTABLE MATERNAL PATHOLOGIES HTA, DIABETES CARDIAC,,,

• FŒTAL• IUGR

• EXTRACARDIAC

FETO MATERNAL TRANSFER

OPTIMAL

• MATERNAL

• NL MATERNAL CLINICAL

AND LAB Toxo, Rubella,

HIV,Hb

• NL DOPPLER INDICES

• FOETAL

• 35 WG

• ESTIMATED WT 2,5KG

• NO EXTRACARDIAC

MALFORMATIONS

POTENTIAL ACTORS

Pr YACOUB FOUNDATION

CHAINE DE L’ESPOIR

Pr LECA MECENAT CHIRURGIE CARDIAQUE

UN CŒUR POUR LA PAIX

BAMBINO GESU/LA SAPIENZA ?

OTHERS

CONCLUSION

• HEAVEN CAN WAIT:

ANOTHER VISION

AND DIMENSION OF

FETAL

&PERINATAL

CARDIOLOGY

CONCLUSION

• THE MISSING

RING FOR

HUMINATARIAN

CARDIAC

ASSOCIATIONS

IMPROVE THEIR

EFFICACY

CONCLUSION

• DESPITE THE FACT

THAT REALISATION

AT BIG SCALE WILL

MEET MANY

DIFFICULTIES

BUT…..