07 m guirgis heaven can wait
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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
• 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
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
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