We herein report a rare case of subaortic stenosis in association with a previous tetralogy of Fallot (TOF) surgical repair, which was not taken into account as a differential diagnosis. Echocardiography plays a pivotal role in identification of this rare combination. Therefore, echocardiography should be performed periodically during follow-up of patients with surgically corrected TOF. Given the clinical complications that can result from subaortic stenosis (i.e., aortic regurgitation and infective endocarditis), early and aggressive management of this rare combination should be performed.
Adult ; Aortic Valve Insufficiency/etiology ; Discrete Subaortic Stenosis/*complications/surgery/ultrasonography ; Echocardiography ; Female ; Heart Defects, Congenital/*complications/surgery/ultrasonography ; Humans ; Tetralogy of Fallot/*complications/surgery/ultrasonography ; Time Factors

OBJECTIVES: To explore the method and significance of prenatal counseling in cardiac surgery for fetal congenital heart disease (CHD). METHODS: The prenatal counseling should be provided by experienced CHD experts. The preliminary clinical diagnosis based on relevant data was carried out, the prognosis risk for fetal CHD was graded, and the pathophysiological process and potential hazards of the disease were analyzed. The current condition of CHD in the treatment plan, the long-term quality of life, and the special requirements of parturition in place, period and mode were described. A reliable follow-up system of the fetuses was established, the diagnosis after delivery was verified, and surgical treatment was carried out timely. RESULTS: From January 2016 to December 2018, 225 parents with fetal CHD received prenatal counseling, including 60 fetuses (26.7%) with simple CHD and 165 (73.3%) with complex CHD, among which 59 cases (98.3%) and 93 cases (56.4%) decided to continue the pregnancy, respectively. During the follow-up, 118 fetuses were born, of which 66 infants received surgical treatment within 6 months after birth, 63 infants (95.5%) recovered and 3 infants (4.5%) died. The rest 52 infants continued to be followed up. CONCLUSIONS The prenatal counseling for fetal CHD can provide the parents a comprehensive medical information about CHD, which is beneficial to making appropriate pregnancy decisions, and can turn the fetuses from unreasonable birth and passive treatment to selective birth and active treatment in CHD.
Cardiac Surgical Procedures ; Counseling ; Female ; Fetus ; Heart Defects, Congenital ; surgery ; Humans ; Pregnancy ; Prenatal Diagnosis ; Quality of Life ; Ultrasonography, Prenatal

Animals ; Female ; Fetal Heart ; abnormalities ; diagnostic imaging ; surgery ; Heart Defects, Congenital ; diagnostic imaging ; physiopathology ; surgery ; Humans ; Pregnancy ; Treatment Outcome ; Ultrasonography, Prenatal

The diagnostic accuracy of echocardiography alone and the safety of cardiac surgery using this diagnostic approach were retrospectively assessed in 111 children operated for congenital heart defects (CHD) during a 3.5-yr period ending in October 2001. Preoperative diagnosis was compared with the intraoperative findings obtained by surgical inspection. Perioperative death was defined as death within 30 days postoperatively. Of the patients, 70% were operated on in infancy. Seventy-six percent (84 of 111) underwent surgery after echocardiographic diagnosis alone. A high percentage of patients with patent ductus arteriosus (100%), partial atrioventricular canal (100%), coarctation of the aorta (89%), ventricular septal defect (86%), atrial septal defect (85%), and total anomalous pulmonary venous connection (75%) was operated without prior catheterization. Diagnostic errors occurred in 2.4% (2 of 84) of patients with echocardiography only and in 7.4% of patients with catheterization. No error in either group was related to surgical morbidity or mortality. There were five (6.0%) perioperative deaths in the echocardiography group and two (7.4%) in the catheterization group, with no difference in the mortality between the groups. In conclusion, many patients with CHD can be accurately diagnosed by echocardiography alone, and can safely undergo surgery without catheterization, not increasing the overall risk.
Adolescent ; *Cardiac Surgical Procedures ; Child ; Child, Preschool ; Diagnostic Errors ; *Echocardiography ; Heart Catheterization ; Heart Defects, Congenital/*surgery/*ultrasonography ; Humans ; Infant ; Infant, Newborn ; Perioperative Care ; Predictive Value of Tests ; Retrospective Studies

Animals ; Aortic Valve ; surgery ; Aortic Valve Stenosis ; congenital ; therapy ; Balloon Valvuloplasty ; methods ; Cardiac Surgical Procedures ; adverse effects ; methods ; Catheterization ; adverse effects ; methods ; Female ; Fetal Diseases ; therapy ; Fetal Heart ; surgery ; Heart Defects, Congenital ; therapy ; Humans ; Postoperative Complications ; epidemiology ; Pregnancy ; Pregnancy Trimester, Second ; Ultrasonography, Interventional ; methods