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On January 14, the Chinese fetal heart defects diagnosis and treatment integrated group, promoted by the Heart Center of Shanghai Children's Medical Center affiliated to Shanghai JiaoTong University School of Medicine, was established under the guidance ofChinese Society for Thoracic and Cardiovascular Surgery,ChineseSocietyfor Pediatric Surgery, Chinese Society of Perinatal Medicine.The Chinese consensus on diagnosis standard, clinical assessment, and multidisciplinary management offetal heart defects was jointly issued in the same period, which will fill the gap in domestic lack of prognosis and multidisciplinary management scores for fetal medicine, and provide scientific guidance for the diagnosis and treatment of nearly 300,000 suspected heart defects in the country every year.
As one of the most common congenital malformations, Congenital heart disease (CHD), accounting for up to one-third of neonatal major birth defects, is one of the important causesof perinatal and infant death. In 2011, asystematic review about the pathogenesis of congenital heart disease, analyzing 114 articles in 70 years, was published by the Journal of the American College of Cardiology, revealing that the global incidence of CHD was increased to 9.1 ‰, almost 15 times of that in the 1940s (which was 0.6 ‰). In China, the incidence of CHD is as high as 8 ‰, which not only ranks first among thecauses of birth defects(accounting for 26.7%), but also becomes the fastest growing detection rate for birth defects (3.56 times of that in 2000).
With the rapid development of prenatal diagnostic techniques, most heart birth defects can already be found in pre-natal deformity screening. According to statistics, up to 95% of severe cardiac birth defects can be detected with the combination of prenatal ultrasound and fetal cardiac MRI. However,it brings about a social problem that when fetal heart defects are discovered, how can our parents determine the fate of the fetus scientifically?
At the heart centers in our country, the overall success rate of operations for CHD is more than 98%, and these children will grow up with the same intelligence and activity ability as those of normal children. In other words, most of the congenital heart diseases can be cured and the prognosis is much better than many other common diseases in pediatrics, such as leukemia, malignant tumors, megacolon, autism. But it is true that a small number of serious heart birth defects will bring a heavy burden to their families due to the expensivetreatment after birth or the seriouspostoperative complications.
Medicinehas been greatly developedwith an obvious trendin the past two decades, while fetal heart medicine is still a “blind zone” in China. Obstetricians and specialists in prenatal diagnosis can detect the abnormal cardiac development, but those who are notspecialistsin children’s cardiovascular may not accurately tell subtypes of the heart abnormalities and associated perinatal management and long-term prognosis, not to mention they can provide the families with professional consultation. In addition, general medical institutions may fall 5 to 10 years behind the professional children‘s heart centersin diagnosis, treatment and prognosis, due to the uneven development in children’s cardiovascular field in China. The prominent clinical problem now is the lack of standards forthe diagnosis and clinical classificationof fetal cardiac defects and a detailed evaluating system,withoutwhich doctors and families of children will not be provided with accuratediagnosis, leading to unnecessary abortions, causingpsychological and physical damage to pregnant women, unhelpful to the transportation for the babies with heart birth defects and multidisciplinary integrative management.
In light of the urgency of these problems, the Chinese fetal heart defects diagnosis and treatment integrated group, promoted by the heart center of Shanghai Children‘s Medical Center affiliated to Shanghai JiaoTong University School of Medicine, was established under the guidance of Chinese Society for Thoracic and Cardiovascular Surgery,ChineseSocietyfor Pediatric Surgery, Chinese Society of Perinatal Medicine.This group is made up of the Heart Center of Shanghai Children’s Medical Center, Fuwai Hospital( National Center for Cardiovascular Disease), Guangdong General Hospital and Guangdong Cardiovascular Institute, West China Hospital and West China Second Hospital, Peking University First Hospital,Shengjing Hospital, Women‘s Hospital School of Medicine Zhejiang University, the Children’s Hospital affiliated to Zhejiang University School of Medicine, Nanjing Children‘s Hospital affiliated to Nanjing University and other prenatal diagnosis centers and pediatric cardiac surgery centers in China. Shanghai Children’s Medical Center as the promotor, will be the cooperative leader group in the first year, whileprofessor Liu Jinfen,as anauthority in pediatric cardiac surgery, director of Shanghai Pediatric CHD Institute and director of Shanghai Children‘s CardiovascularClinical Medical Center, will serve as the first group leader.
At the same time, after much discussion, the members of the group have written a consensus on diagnosis standard, clinical assessment, and multidisciplinary management of fetal heart defects in China. The consensus will for the first time establish the diagnosis system for fetal heart defects, on the basis of which, combined with a professional, refining, concise grading, will provide doctors and parents with clearer medical guidance and perinatal fetus integration management strategies. The consensus will fill the gap in domestic lack of prognosis and multidisciplinary management scores for fetal medicine, and provide scientific guidance for the diagnosis and treatment of nearly 300,000 suspected heart defects in the country every year.
Professor Liusays, they will try to setupcollaborations ofthe “prenatal diagnosis + perinatal medicine + children’s heart surgery ” betweenthe main prenatal diagnosis centers and the pediatric cardiovascular centers, carry out professional medical education in fetal cardiology, provideauthoritative diagnosis and consultationfor suspected fetal heart defects around the country, andoffer a convenient “seamless docking and integration” consultation and referral medical servicesaccording to the fetal conditions. Besides, they will cooperate with many well-known Internet medical organizations,followed by strict clinical research plansand comprehensive execution of the expert consensus, and thus provide enough evidence for the expert consensus which may eventually bring it into a clinical guide, and decrease thenon-accidentalmortality of children under 5 years old and improve the quality of the population in our country.