Prenatalna dijagnostika i praćenje fetalnih srčanih grešaka

master's thesis

• Title (english): Prenatal diagnosis and follow-up of fetal cardiac anomalies
• Author: Iva Galić
• Mentor: Berivoj Mišković (mentor)
• Committee member: Vesna Elveđi Gašparović (predsjednik povjerenstva)
• Committee member: Dinka Pavičić Baldani (član povjerenstva)
• Committee member: Berivoj Mišković (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2020-07-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Prirođene srčane greške (PSG) najčešći su uzrok smrti u perinatalnom i dojenačkom razdoblju. U Hrvatskoj 7, 2 promila djece ima PSG-u. Clark je prema etiopatogenetskim kriterijima PSG razvrstao u šest skupina. Fetalna cirkulacija je specifična, a glavno obilježlje je postojanje tri shunta na razini ductus venosus, foramen ovale i ductus Botalli. Isto tako, fetalno srce ima složenu morfološku strukturu te je zbog toga za prenatalnu dijagnostiku PSG-a potrebno adekvatno poznavanje navedenih specifičnosti fetalnog srca. Etiologija PSG-a je multifaktorska, a najčešće se upotrebljava funkcionalna klasifikacija. Prema tim se kriterijima PSG dijele u tri skupine: greške s početnim lijevo – desnim pretokom krvi, greške s početnim desno – lijevim pretokom krvi te greške u kojima je prisutna opstrukcija bez cijanoze. Fetalna ehokardiografija (FE) ima najvažnju ulogu u dijagnostici PSG-a. Najčešća je indikacija za FE-u sumnja na strukturnu abnormalnost fetalnog srca. Ona omogućuje adekvatan nadzor trudnoće, planiranje vremena i načina porođaja te adekvatno zbrinavanje i rano liječenje novorođenčeta. S napretkom FE-e unatrag nekoliko godina neke srčane greške liječe se in utero. Riječ je o intervencijskoj kataterizaciji in utero koja omogućava liječenje aortalne stenoze (AS) s razvijajućim sindromom hipoplastičnog lijevog srca (HLHS), HLHS-a s intaktnim atrijskim septumom, dilatiranog LV-a s teškom mitralnom regurgitacijom i AS-om te pulmonalne atrezije (PA) s intaktnim ventrikularnim septumom. Planirani porod u visoko specijaliziranim centrima ključna je stavka za optimalan ishod djece s PSG-a.

Abstract (english)

Congenital heart defects (CHD) are the most common cause of death in the perinatal and infantile period. In Croatia, 7,2 out of 1000 children are born with CHD. Based on ethiopathogenic criteria, Clark has divided CHD into six groups. The main features of fetal circulation are three shunts that occur at ductus venosus, foramen ovale and ductus Botalli. Fetal heart is morphologically immensely complex and, therefore, thorough understanding of morphology is required for perinatal diagnosis of CHD. Etiology of CHD is multifactorial and functional classification is most commonly used. By these criteria CHD are divided into three groups: defects with initial left to right blood flow, defects with initial right to left blood flow, and obstructive defects that present without cyanosis. Fetal echocardiography has a major role in CHD diagnosis. The most common indication for FE is a suspected structural heart abnormality. FE provides adequate pregnancy monitoring, delivery planning, neonatal care and treatment. With rapid improvement of FE in the past years, it has become possible to treat some CHD in utero. Catheter intervention in utero enables treatment of aortic stenosis (AS) with developing hypoplastic left heart syndrome (HLHS), HLHS with intact atrial septum, dilated LV with severe mitral regurgitation and AS, and pulmonary atresia (PA) with intact ventricular septum. Planned delivery in highly specialized centers is a crucial element for a favorable outcome of CHD.

• Keywords: prirođene srčane greške; fetalna ehokardiografija; intervencijska kataterizacija in utero
• Keywords (english): congenital heart defects; fetal echocardiography; catheter intervention in utero
• Language: croatian
• URN:NBN: urn:nbn:hr:105:100876
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-03-17 10:23:50