**4. Conclusion**

Since approximately, 75% of congenital heart diseases have no identifiable cause or underlying condition, the notion of formal genetic evaluation may appear unwarranted [123]. However with the development and feasibility of genetic evaluations improving, more and more cardiac malformation are being linked to underlying genetic anomalies. Therefore the need to look for a genetic link become more crucial, as more patient with congenital heart disease live into adult age, it is very important that families understand their recurrence risk [120–122]. Unfortunately genetic counseling is not an integral or compulsory part of the treatment plan for families at many centers. Too many times, parents are exhausted from the complex interventional procedures and surgeries and its subsequent complications, the need for such counseling is forgotten and pushed aside [22, 117]. There are likely to be approximately 400 genes involved in the causation of congenital heart disease, many of which are yet to be identified [119]. Therefore the role of genetic counselors, with specialized skills in cardiovascular genetics is of utmost importance in the adult patient with congenital heart disease. Such genetic counselors play a crucial role in providing accurate recurrence risk, facilitating appropriate genetic testing, interpreting of results and appropriate subspecialty referrals. Phenotypic heterogeneity and incomplete penetrance complicate our understanding of the genesis of congenital heart disease. However it seems more likely than ever that our gaps in understanding the causes of congenital heart disease are primarily genetic and that the mechanism are multifactorial [117].

It is know that the prenatal diagnosis of moderate to severe CHD is associated with improved outcomes and reduction in the morbidity in select cardiac defects. Prior knowledge of the cardiac lesion allows, the delivery room team to be prepared with appropriate resources to help minimize hypoxemia and metabolic acidosis. The likely need of invasive ventilation can be assed prior to delivery. Therefore the prenatal counseling allows for an accurate diagnosis of the cardiac defect, with parents educated on the possible interventions and expected outcomes after birth. Counseling and the availability of a multidisciplinary team will give the expectant parents support and allows for them to make informed decision before and after delivery.

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