Prenatal Diagnosis Key to Successful Treatment of Congenital Heart Disease

Not that long ago, the majority of babies who were born with heart defects did not survive their childhood. But thanks to progress in diagnosis, surgical techniques and postoperative care, up to 90 percent of these infants born today will live to become adults. Advances in the ability to treat congenital defects make prenatal diagnosis of the problem more critical than ever, says Brian Reemtsen, M.D., director of the Congenital Heart Surgery Program at Mattel Childrens Hospital UCLA. For these very sick patients, he adds, optimal care is provided when we know what to expect from the patient before birth.

Dr. Reemtsen stresses the importance of proper prenatal care, including routine ultrasounds. A family history of congenital heart disease and the detection of any other anomaly in the course of these screenings are among the biggest risk factors for congenital heart disease. Identifying babies with congenital heart defects in utero can be life saving, says Thomas Klitzner, M.D., Ph.D., chief of pediatric cardiology at UCLA.

Cutting-edge imaging technologies — such as fetal echocardiography, three-dimensional echocardiography and the ability to see increasingly smaller structures on CT scans and cardiac MRI — have greatly enhanced physicians ability to view the anatomy of the fetal and infant heart, which is roughly the size of a walnut.

Hypoplastic-left-heart syndrome, among the most-common congenital defects, was considered a fatal disease two decades ago; today, though they require multiple surgeries, the vast majority of these children survive into adulthood.

The key is not only good surgery, but also excellent pre- and postoperative care, Dr. Reemtsen explains. That is where the multidisciplinary approach makes all the difference for these extremely sick patients. At Mattel Childrens Hospital UCLA, for example, the Congenital Heart Surgery Program benefits from partnerships with the Interventional Cardiology Program, where advances in the use of balloons and catheters have improved postsurgical care; and the Pediatric Electrophysiology Program, where experts are available to treat arrhythmias.

In addition, labor-and-delivery at UCLA is on the same floor as the Pediatric Heart Center so that any procedure needed for an infant can be done without delay or the need to transfer from one facility to another.

Patients who require it also benefit from advances in heart transplantation. Recent developments include the advent of a pediatric ventricular-assist device. The Berlin Heart is the first such device made specifically for the pediatric population. It is helping to serve as a bridge for patients with failing hearts who might otherwise die while waiting for a transplant.