Brief Answer:
For ahead with the pregnancy under monitoring, get a fetal echo done

Detailed Answer:
Hello, I am Dr Mody and I will be addressing your concern.
I would enumerate my views so that we can be objective as my colleague have already discussed important aspects about the condition
1) As tee is done, without doubt she has sinus venous asd with papvc.
2) surgery is the only option at present as the non Invasive device closure hasn't developed beyond research for the condition
3) surgery is safe in experienced hand with good long term results
4) we are lucky in context that the pregnancy helped us make an accurate diagnosis and it hasn't progressed to irreversible and complicated stages
5) however because the right heart is dilated and according to the RVSP, she has mild pulmonary hypertension, and the shunt is more than 1.5 she does require surgery.
Now coming to your questions,
Where do we stand and what are ways forward
Preferred
1) we carry on the pregnancy with close monitoring during pregnancy and more importantly during delivery so if any complications occur we can tide over it. A local cardiologist and experienced gynecologist will be able to do so.
Why is this the preferred option.
The pulmonary pressure are not very high and she will be able to tolerate the pregnancy well as already 12 weeks are done , she should be able to move good as I don't forsee any acute change in hemodynamics which would be detrimental to the mother or baby as during pregnancy both systemic and pulmonary pressures fall. As already 12 weeks are done if the baby has asd or other congenital anomaly, it's already developed. And even post correction after the surgery, the transmission rate remains the same even for the next baby. Also there is no direct association, it's just some unknown genes which may result fetal transmission, because in studies we found more incidence in children of parents who had asd.
So a good fetal echo will be able to rule that out, and if the baby has any complex congenital disease one can contemplate terminating, otherwise the baby should do good. The exact number have varied in different studies. But in XXXXXXX population it is less than 2%, which I believe is worth the take.
6) so carry on the pregnancy, and asd closure post delivery.
7) serial echo to monitor pulmonary pressure and other changes in hemodynamics will help the treating doctor.
8)if we terminate the pregnancy and get surgery done, ya that on paper the best way forward but the added benefit would be just less monitoring required in next pregnancy, as even at present the risk to mother is less than 1%, which I believe every high risk presence has.
9) the expected complications are.
As I can predict the decrease in pulmonary and systemic pressure, so some change in the shunt, however literature and my experience both proves it wouldn't be clinically significant, rise in pulmonary pressure, again this wouldn't be significant. However other factors like anemia should be properly managed more stringently as compared to a normal pregnancy. In deliver a planned cesarean section with infective endocarditis prophylaxis to be on safest side, however the gynecologist may take the final call .
It's something where we will have to modify our approach as the pregnancy progresses.
More discussion will rather create a false apprehension.
Finally get a good local gynecologist and cardiologist and under proper surveillance go ahead with the pregnancy.
My observations are based on standard XXXXXXX and European guidelines.
Any query I would be happy to clarify. Do upload complete so I can go through exact dimension
Regards Dr Priyank Mody, Lilavati Hospital, XXXXXXX

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Brief Answer:
All the best , may god bless the mother and the baby :)

Detailed Answer:
Hello

NT scan and the double marker should be god enough at this juncture of pregnancy , Generally i get my fetal echo done by 16 weeks , due to the legal time till 20 weeks for taking a decision , is very simple the later you do more easier an accurate it is , however post 6 weeks a good radiographer or pediatric cardiologist can give a good result . so the call is yours

For your wife , i would sugges monthy follow p atleast with your gynecologist , to make sure everything is on track . however if any breathlessness , palpitation ( various supraventricular tachycardia are more common as compared to normal pregnancy ) or swelling in the legs , than you consult your doctor .

Now why no furthur test ? every new test has high false positive numbers and add to unnecessary anxiety .
our two aims , your wife going through un eventful pregnancy , and making sure the baby is free of any complex congenital heart disease are both taken care of , by the tests and routine follow up already as decided .
Hoping I could Help . Regards Dr. Priyank Mody

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