Progression of congenital heart disease in the prenatal period

Background: Prenatal echocardiography has shown evidence of prenatal develo pment of congenital heart disease. Prenatal cardiac anatomy, chamber size a nd function change during gestation, so that the appearance of cardiac stru cture in abnormal hearts may be different from that which is usually seen p ostnatally. Methods: Published prenatal echocardiographic studies were reviewed and in utero development of congenital heart disease from midtrimester to the earl y postnatal period is discussed. Results: The growth of the great vessels and ventricles is reduced in fetus es with ventricular outflow obstruction. Valve regurgitation may progress. The foramen ovale and ductus arteriosus have been reported to become restri ctive in utero in several settings. Pulmonary vascular obstructive changes may progress prenatally. Fetal arrhythmia (both bradycardia and tachycardia ) may develop in utero. Development of congestive heart failure is a very i mportant issue during follow up of fetuses with significant cardiac or extr a-cardiac problems. Some may progress to fetal hydrops and prognosis of the affected fetuses is usually very poor. Conclusions: Correct knowledge of possible development is important for acc urate prenatal diagnosis. Information on prenatal progression of the cardia c anomaly is also important to make plans for follow up and perinatal manag ement, to predict outcomes and to counsel family. Furthermore, the benefits of prenatal treatment instead of postnatal treatment should be assessed by the accurate prediction of the progression of the cardiac problem in utero . Further extensive studies using a large number of cases is required to pr edict progression accurately. In addition, further studies for elucidating the mechanisms of progression is important to provide better outcomes for f etuses with various congenital heart diseases.