ABC | Volume 112, Nº5, May 2019

Guideline Brazilian Fetal Cardiology Guidelines – 2019 Arq Bras Cardiol. 2019; 112(5):600-648 Optional elements (classes IIa and IIb) Cardiac and general biometry Cardiothoracic ratio Atrial dimensions Ventricular dimension Atrioventricular valve diameters Semilunar valve diameters Ascending aortic and main pulmonary artery diameters Aortic and ductal arch diameters Branch pulmonary artery diameters Fetal biometry Color doppler Umbilical vein and arteries Pulsed-wave doppler Superior and inferior vena cavae Right and left pulmonary arteries Middle cerebral artery Other doppler modalities Continuous-wave doppler Tissue doppler Additional cardiac function indexes Ventricular shortening fraction Myocardial performance index Calculation of cardiac output regionally as follows: 2,758 cases in the North Region; 7,570 in the Northeast; 10,112 in the Southeast; 3,329 in the South, and 1,987 in the Central West. 36 In 2010, the Live Births Information System ( Sistema de Informação sobre Nascidos Vivos , SINASC) of the Ministry of Health, had 1,377 cases of live births with CHD notified. This represents only 5.3% of the estimated number. 36 There are currently approximately 40 services accredited by the Ministry of Health to perform pediatric cardiac surgery, with a rather heterogeneous distribution, concentrated mainly in the South and Southeast Regions (62%). In accordance with 2002 data from the Brazilian Unified Health System’s Department of Informatics ( Departamento de Informática do Sistema Único de Saúde , DATASUS), the deficit in cardiac surgery for CHD in the North and Northeast Regions was 93.5% and 77.4%, respectively. 32,33 As the implantation of Fetal Cardiology is directly related to pediatric cardiac surgery services, the current situation in Brazil, with respect to fetal diagnosis, continues to be considerably heterogeneous. 34 According to their potential therapeutic facilities, Fetal Cardiology centers were stratified on three specific levels: • Level 1: Centers that can diagnose structural and functional fetal cardiac anomalies, make the follow- up of the affected fetuses and, stablishe the delivery planning according to the fetal heart disease. • Level 2: Centers where, in addition to the fetal diagnoses of structural and functional fetal cardiac anomalies, have a multidisciplinary team with obstetricians, pediatric cardiologists, interventional cardiologists, and pediatric cardiac surgeons, and can provide the postnatal therapy. • Level 3: Centers where, in addition to diagnosis and follow-up of the affected fetuses, have a multidisciplinary team with obstetricians, pediatric cardiologists, interventional cardiologists, and pediatric cardiac surgeons and provide invasive intrauterine interventions. Currently, in Brazil, the majority of Pediatric Cardiology centers are considered levels 1 or 2. Intrauterine interventions are restricted to a very small number of fetuses with very specific pathologies and 613