This document proposes a new international project called "Heaven Can Wait" to address critical congenital heart disease in developing countries. It involves establishing prenatal cardiac screening programs and transferring high-risk fetal-maternal pairs to centers in Europe for delivery and cardiac surgery. This aims to give neonates the best chance for treatment and survival, while also improving the efficacy of humanitarian cardiac organizations by providing them with prenatally detected cases. Though large-scale implementation faces challenges, the project envisions adding a new dimension to fetal and perinatal cardiology to help address the stark contrast in outcomes between developed and developing world contexts.

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. INITIAL VISION IN FETAL
CARDIOLOGY
VERS UNE CARDIOLOGIE PRENATALE
« THE FETUS AS CARDIAC PATIENT »
Jean Kachaner & Laurent Fermont
Presse Médicale 1984

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. 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. ZOOM ON ACTUAL ORIENTATION
• VERY EARLY
DIAGNOSIS :
• NO ACCURATE PROGNOSIS
POSSIBLE IN BORDERLINE
CASES: LACK OF STUDY OF
EVOLUTIVITY POTENTIAL
-> TOP

6. ZOOM ON ACTUAL ORIENTATION
NO TIME TO STUDY EVOLUTION
TOP

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. ZOOM ON ACTUAL ORIENTATION
• CARDIAC ANOMALY AS
SIGN OF GENETIC DIS.
• LINEAR INSERTION OF
AV VALVES
PRESSURE ON
CARDIOLOGISTS

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. 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. CONTRASTING SITUATIONS
EUROPE : HIGH DETECTION , HIGH SELECTION AIMING
TO PERFECT BABY
DEVELOPPING COUNTRIES : HOPELESS SITUATION

12. TIME FOR CHANGE?
ADDING A NEW DIMENSION FOR FETAL
AND PERINATAL CARDIOLOGY ?

13. HEAVEN CAN WAIT
THE STORY

14. HEAVEN CAN WAIT
THE STORY
FEBRUARY 2008
TEACHNING COURSE FETAL
HEART FOR OBSTETRICIANS &
RADIOLOGISTS IN MAURITUS

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. 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. 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. 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. FETO MATERNAL TRANSFER
CONTRAINDICATIONS
• MATERNAL
• PLACENT PRAEVIA
• RISK OF PMD
• UNSTABLE
MATERNAL
PATHOLOGIES
HTA, DIABETES
CARDIAC,,,
• FŒTAL
• IUGR
• EXTRACARDIAC

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. 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. CONCLUSION
• HEAVEN CAN WAIT:
ANOTHER VISION
AND DIMENSION OF
FETAL
&PERINATAL
CARDIOLOGY

23. CONCLUSION
• THE MISSING
RING FOR
HUMINATARIAN
CARDIAC
ASSOCIATIONS
IMPROVE THEIR
EFFICACY

24. CONCLUSION
• DESPITE THE FACT
THAT REALISATION
AT BIG SCALE WILL
MEET MANY
DIFFICULTIES
BUT…..