Table 5.5.

Group IIA. Structural fetal heart diseases that inevitably require 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
Simple TGA HLHS IAA Severe CoA TAPVR Truncus Complex heart diseases with severely restricted systemic or pulmonary outflow tracts	FO may be restrictive during gestation Although they are complex heart diseases, they tend to remain stable, without hemodynamic compromise during gestation	Repeat study every 4 to 6 weeks is recommended In HLHS or anatomical variations with restrictive ASD, consider fetal intervention Perform a new evaluation a few weeks before delivery	Induced vaginal delivery or programmed C-section Level 2 or 3 center	Immediate neonatal cardiac evaluation The majority are duct dependent CHD and require prostaglandin infusion + interventional or surgical treatment during the first week of life TAPVR and Truncus are diseases with early presentation of HF and PH, and thus require treatment during the first weeks of life, even when they are not duct dependent

CoA: coarctation of the aorta; FO: foramen ovale; HF: heart failure; HLHS: hypoplastic left heart syndrome; IAA: interrupted aortic arch; PH: pulmonary hypertension; TAPVR: total anomalous pulmonary venous return; TGA: transposition of great arteries.