ABC | Volume 112, Nº5, May 2019

Guideline Brazilian Fetal Cardiology Guidelines – 2019 Arq Bras Cardiol. 2019; 112(5):600-648 Table 5.1 – Group IA. Structural fetal heart diseases without in utero hemodynamic compromise, which do not require immediate neonatal care. Class of recommendation/level of evidence: IB. 17,41,57-59 Heart disease In utero outcome In utero follow up Delivery Postnatal assessment VSD AVSD ASD Ao-P window Stable Repeat the study a few weeks before birth is recommended Delivery type according to obstetric indication Level 1 center Maternity ward or outpatient clinic Ao-P: aortopulmonary; ASD: atrial septal defect; AVSD: atrioventricular septal defect; VSD: ventricular septal defect. Table 5.2 – Group IA. Structural fetal heart diseases without in utero hemodynamic compromise that may progress during fetal life and may or may not require immediate neonatal care. Class of recommendation/level of evidence: IB. 17,41,57-59 Heart disease In utero outcome In utero follow up Delivery Postnatal assessment TOF DORV Complex TGA CTGA TA May progress to significant obstruction to systemic or pulmonary outflow tracts After diagnosis, repeat the study every 4–6 weeks A new study a few weeks before birth is highly recommended Delivery type according to obstetric indication Level 1; Level 2 or 3 centers in case the in utero hemodynamic condition worsens or precipitates immediate neonatal decompensation (significant obstruction of the systemic or pulmonary outflow tracts) In all cases, before hospital discharge, cardiac assessment with echocardiogram is required CTGA: corrected transposition of great arteries; DORV: double outlet right ventricle; TA: tricuspid atresia; TOF: tetralogy of Fallot; TGA: transposition of great arteries. Table 5.3 – Group IB. Functional fetal heart diseases without in utero hemodynamic compromise, that not require immediate neonatal care. Class of recommendation/level of evidence: IB. 17,41,57-59 Heart disease In utero outcome In utero follow-up Delivery Postnatal assessment Atrial or ventricular extrasystoles Mild TR Stable Repeat the study a few weeks before birth is recommended Delivery type according to obstetric indication Level 1 center Maternity ward or outpatient clinic TR: tricuspid regurgitation. Table 5.4 – Group IIA. Structural fetal heart diseases with possible in utero hemodynamic compromise and chance of fetal treatment, which require immediate neonatal care. Class of recommendation/level of evidence: IB. 17,41,57-59 Heart disease In utero outcome In utero follow-up Delivery Postnatal assessment PS PAIVS AS Ebstein’s anomaly Risk of ventricular hypoplasia Risk of ventricular dysfunction or fetal hydrops Risk of circular shunt Risk of fetal arrhythmia Repeat the study every 2 to 4 weeks is recommended If signs of in utero progression, consider fetal intervention between 22 and 32 weeks If circular shunt, consider induced ductal constriction Without hydrops, induced vaginal delivery or programmed C-section With hydrops, programmed C-section Level 2 or 3 center Immediate neonatal cardiac assessment PAIVS requires neonatal treatment Severe or critical PS and AS, may require neonatal treatment Ebstein’s anomaly needs treatment if pulmonary atresia and lung hypoplasia AS: aortic stenosis; PAIVS: pulmonary atresia with intact interventricular septum; PS: pulmonary stenosis. 618