ABC | Volume 112, Nº5, May 2019

Guideline Brazilian Fetal Cardiology Guidelines – 2019 Arq Bras Cardiol. 2019; 112(5):600-648 Figure 2.7 – Short axis view of the great vessels. This plane shows the relationship between the great arteries, with the aorta being in the center of the heart and posteriorly and the right ventricular outflow tract surrounding the aorta anteriorly. This is an excellent plane for identifying perimembranous ventricular septal defects and pulmonary obstructions due to the anterior deviation of the infundibular septum observed in the tetralogy of Fallot. Ao: aorta; DAo: descending aorta; LPA: left pulmonary artery; PA: pulmonary artery; RPA: right pulmonary artery; RV: right ventricle. LPA PA RPA RV DAo Recommendation IIa) or may be reasonable (Class of Recommendation IIb) were distinguished (Table 2.4). 17 3. Stratification of Centers that Work with Fetal Cardiology and their Potential Therapeutic Facilities Congenital heart diseases are the most frequently malformations related to morbimortality in infancy, especially during the prenatal period. 26 Its incidence has been estimated as 6 to12 cases per 1,000 live births. During fetal life, it may be up to 5 times higher, being the difference justified by fetal losses. 27-29 Approximately 50% of cases have early hemodynamic consequences, requiring catheter or surgical interventions during the first year of life. 17 Extracardiac malformations may be observed in up to 50%, further increasing pre- and postoperative morbimortality. 30 It is worth highlighting that, in developed countries, treatment for CHD compared to other congenital anomalies, have the highest hospital costs. 31 Over the past years, first-trimester ultrasounds and, widespread use of fetal echocardiography have contributed to increase the rates of fetal diagnosis of CHD and consequently, improve perinatal outcome. However, fetal echocardiography has not become universally available in Brazil yet, with the majority of professionals trained in Fetal Cardiology being concentrated in the South and Southeast Regions and a more restricted number in the North, Northeast, and Central-West Regions. In the states located in these latter regions, the availability of this tool is mainly restricted to the capital cities and is of low availability in Brazil’s public healthcare system ( Sistema Único de Saúde , SUS). 32-34 There is a decreasing tendency of Brazil’s infant mortality rates over the last years, with a 77% decline over 22 years, from 62 deaths per 1,000 live births in 1990 to 14 per 1,000 in 2012. 35 Deaths during the first year of life represent 90% of mortality in the 0-4 age group, with 68% occurring between 0 and 28 days. Congenital cardiac anomalies have been identified as responsible for a significant part of these rates, especially during the neonatal period. 35 It is estimated that there are approximately 25,700 new cases of CHD per year in Brazil, which are distributed 611