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07 m guirgis heaven can wait

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07 m guirgis heaven can wait

  1. 1. HEAVEN CAN WAIT A NEW VISION &ORIENTATION IN PERINATAL CARDIOLOGY INTERNATIONAL PROJECT Prof. Maurice GUIRGIS FETAL & PEDIATRIC CARDIOLOGY UNIT Hôpital Bichat– University Paris VII
  2. 2. INITIAL VISION IN FETAL CARDIOLOGY VERS UNE CARDIOLOGIE PRENATALE « THE FETUS AS CARDIAC PATIENT » Jean Kachaner & Laurent Fermont Presse Médicale 1984
  3. 3. 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
  4. 4. 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
  5. 5. ZOOM ON ACTUAL ORIENTATION • VERY EARLY DIAGNOSIS : • NO ACCURATE PROGNOSIS POSSIBLE IN BORDERLINE CASES: LACK OF STUDY OF EVOLUTIVITY POTENTIAL -> TOP
  6. 6. ZOOM ON ACTUAL ORIENTATION NO TIME TO STUDY EVOLUTION TOP
  7. 7. 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
  8. 8. ZOOM ON ACTUAL ORIENTATION • CARDIAC ANOMALY AS SIGN OF GENETIC DIS. • LINEAR INSERTION OF AV VALVES PRESSURE ON CARDIOLOGISTS
  9. 9. ZOOM ON ACTUAL ORIENTATION IMPACT 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 Anomalies 16 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%
  10. 10. 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
  11. 11. CONTRASTING SITUATIONS EUROPE : HIGH DETECTION , HIGH SELECTION AIMING TO PERFECT BABY DEVELOPPING COUNTRIES : HOPELESS SITUATION
  12. 12. TIME FOR CHANGE? ADDING A NEW DIMENSION FOR FETAL AND PERINATAL CARDIOLOGY ?
  13. 13. HEAVEN CAN WAIT THE STORY
  14. 14. HEAVEN CAN WAIT THE STORY FEBRUARY 2008 TEACHNING COURSE FETAL HEART FOR OBSTETRICIANS & RADIOLOGISTS IN MAURITUS
  15. 15. 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 PARIS CONFIRMATION 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 »
  16. 16. HEAVEN CAN WAIT EMBRYO OF PROJECT OBJECTIVES (1) FETO MATERNAL TRANSFER FOR DELIVERY AND CARDIAC SURGERY IN CRITICAL HD SIMPLE TGA / COARCTATION BEST 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
  17. 17. 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)
  18. 18. 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
  19. 19. FETO MATERNAL TRANSFER CONTRAINDICATIONS • MATERNAL • PLACENT PRAEVIA • RISK OF PMD • UNSTABLE MATERNAL PATHOLOGIES HTA, DIABETES CARDIAC,,, • FŒTAL • IUGR • EXTRACARDIAC
  20. 20. 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
  21. 21. POTENTIAL ACTORS Pr YACOUB FOUNDATION CHAINE DE L’ESPOIR Pr LECA MECENAT CHIRURGIE CARDIAQUE UN CŒUR POUR LA PAIX BAMBINO GESU/LA SAPIENZA ? OTHERS
  22. 22. CONCLUSION • HEAVEN CAN WAIT: ANOTHER VISION AND DIMENSION OF FETAL &PERINATAL CARDIOLOGY
  23. 23. CONCLUSION • THE MISSING RING FOR HUMINATARIAN CARDIAC ASSOCIATIONS IMPROVE THEIR EFFICACY
  24. 24. CONCLUSION • DESPITE THE FACT THAT REALISATION AT BIG SCALE WILL MEET MANY DIFFICULTIES BUT…..

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