From fetal detection to lifelong congenital heart disease care: A narrative review of research progress

Abstract

Pediatric cardiology has shifted from survival-focused care toward earlier detection, timely intervention, individualized treatment pathways, and lifelong follow-up. Recent literature reflects major progress in fetal diagnosis, neonatal stabilization, surgical and catheter-based treatment, transition to adult congenital heart disease care, and long-term outcome surveillance. This review summarizes current research directions in congenital heart disease, with emphasis on the continuum from fetal detection to lifelong care. Recent studies on fetal echocardiography suggest that this modality is increasingly linked to delivery planning, neonatal stabilization, counseling, and prediction of postnatal needs. Early intervention has also become more pathway-based, involving stabilization, maintenance of ductal patency when needed, safe transfer, surgical or catheter-based treatment, and perioperative risk reduction. However, early treatment does not always mean immediate complete repair, as timing should be individualized according to lesion severity, clinical stability, anatomy, and institutional expertise. Surgical, catheter-based, and hybrid pathways have expanded treatment options, allowing definitive repair, staged palliation, bridge therapy, and reintervention. As survival improves, transition to adult congenital heart disease care has become a central issue. Structured transition programs, follow-up databases, lesion-complexity stratification, and active recall systems are needed to prevent loss to follow-up and support lifelong surveillance. Future research should move beyond mortality and procedural success alone by integrating patient-centered outcomes, registries, artificial intelligence-supported risk prediction, and implementation studies.