Perinatal Cardiology Part 2

Edward Araujo Júnior, Nathalie Jeanne M. Bravo-Valenzuela, Alberto Borges Peixoto

• Publisher: Bentham Science Publishers
• Year: 2020
• ISBN:
  9789811466557
• Topic: Medicine
• Subtopic: Perinatology & Neonatology

In Perinatal Cardiology, fetal cardiology experts provide key information on tools for fetal evaluation through echocardiography / cardiac ultrasonography, with a primary focus on the nature and prenatal detection of structural and functional cardiac heart defects (CHDs). In this two-part book, readers will find details about different types of fetal cardiac abnormalities along with important updates on the diagnosis, management, planning delivery, and postnatal treatment in CHD cases. This information is supplemented with guidelines for the clinical management of patients with a fetus affected by cardiovascular defects, and surgical procedures in neonates. Key Features:
-presents information gathered by experts in perinatal cardiology, organized into 26 topic-based chapters
- explores the cardiac development, fetal cardiovascular hemodynamics, genetic and environmental factors associated with congenital heart defects (CHD), perinatal management, planning delivery, and postnatal treatment of newborns with CHD
- presents information about normal cardiac functions and heart defects to give readers a clear and detailed picture of abnormal cardiac function
- presents information about perinatal ultrasound physiology
- gives practical guidelines for ultrasound and echography parameters required for evaluating fetal heart anatomy and diagnosing diseases
- includes a new system of classifying prenatal CHDs based on the stratification of the risk level of care
- features a straightforward and accessible style of presentation suitable for all readers
- provides references in each chapter for further reading Part 2 of this two-part set delves into different fetal anomalies such as ventricular inflow anomalies, myocardial and pericardial diseases, cardiac tumors, extra-cardiac conditions, cardiac failure, and environmental factors associated with CHD. The latter chapters cover clinical topics such as labor management for patients bearing a child with CHD, fetal cardiac interventions, clinical management of neonates with CHD and postnatal surgery. Perinatal Cardiology is an essential reference for postgraduate medical students seeking to improve their knowledge of fetal and pediatric cardiology as part of their residency and professional training. The book equips readers with the information necessary to understand the role of the perinatal cardiologist and goes further to facilitate the ability to perform adequate risk assessments for fetal CHD.

Environmental Factors Associated with Congenital Heart Diseases

Ana Luisa Neves^*

Department of Pediatric Cardiology, University Hospital Center of S. João; Faculty of Medicine, University of Porto, Porto, Portugal

Abstract

Congenital heart diseases (CHD) are common, of largely unknown etiology, with high mortality. This chapter presents the available information on environmental factors that may alter the risk for CHD. Information regarding parental characteristics and conditions, maternal therapeutic drug exposures, parental nontherapeutic drug exposures, and environmental exposures are presented. Aside from some cardiac teratogens and prenatal maternal conditions or exposures associated with an increased risk for CHD, such as thalidomide, and retinoids, smoking, maternal rubella infection, phenylketonuria, hypertension, and diabetes, studies investigating most of environmental risk factors have yielded conflicting results. Associations were found for febrile illness, in vitro fertilization, stressful life events, hyperhomocysteinemia, obesity, hypertension, antihypertensives, bronchodilators, anticonvulsant drugs, non-therapeutic drugs, alcohol, air pollution, disinfectant products, pesticides, solvents, metals and landfill/hazardous waste sites. Some principles for prevention can be useful, as preconception and prenatal care with specific attention to the intake of folic acid, vaccination for rubella, detection and effective management of phenylketonuria, hypertension, and diabetes, discussion of any medicine use, avoidance of infections and chemical exposures, alcohol, smoking, and non-therapeutic drugs. Women receiving therapeutic drugs should be regularly monitored. In addition, screening for CHD should be performed when environmental risk factors are present. Further investigations for the development of prevention and intervention are needed.

Keywords: Air pollution, Alcohol, Chemical exposure, Congenital heart disease, Diabetes, Disinfectant by-products, Drug exposures, Environmental risk factors, Etiology, Febrile illness, Folic acid, Hazardous waste sites, Hypertension, Infection, Obesity, Rubella, Smoking, Solvents, Teratogens, Vitamin A congeners/retinoids.

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^* Address Correspondence Ana Luisa Neves: Department of Pediatric Cardiology, Centro Hospitalar Universitário de S. João, E.P.E., Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal; E-mail: [email protected]

INTRODUCTION

The incidence of moderate and severe forms of congenital heart disease (CHD) is about 6/1,000 live births [1]. Scarce information is available regarding the adverse effect of environmental risk factors in CHD [2]. More than 66% of congenital defects relate to unknown, most likely multifactorial causes, including environmental risk factors [3]. Environmental exposure refers to any factor that is not genetic, and more specifically to the fetal-placental-maternal environment [3]. Increased knowledge about environmental factors could allow preventive strategies to reduce CHD [2]. Environmental risk factors are divided into four categories: parental demographics or conditions, maternal therapeutic drug exposures, parental nontherapeutic drug exposures, and parental environmental exposures [4].

Environmental factors associated with congenital heart diseases

Demographic and Conditions

Demographics

Maternal age is associated with CHD [5^-10]. In the Baltimore-Washington Infant Study (BWIS), advanced maternal age was found to be associated with an increased risk of Ebstein’s anomaly and d-transposition of the great arteries (d-TGA). Younger age was associated with tricuspid atresia [11]. The Metropolitan Atlanta Congenital Defects Program, identified older mothers as more likely to have a child with an atrial septal defect (ASD), coarctation of the aorta (CoA), or d-TGA [5]. In the USA, a detailed analysis of the National Birth Defects Prevention Study (NBDPS) database, advanced maternal age was associated with ASD, tetralogy of Fallot (TOF), and ventricular septal defects (VSD), whereas younger maternal age was associated with total anomalous pulmonary venous return and tricuspid atresia. Paternal age was found to be [12] associated with CHD [8, 9]. A matched case-control study identified an association between advanced paternal age and VSD [9].

Diabetes

Pregestational diabetes has an absolute risk of CHD of 3–5% live births, relative ri...