Prenatal diagnosis of cardiovascular diseases

Abstract

Fetal echocardiography is a safe means to obtain reliable anatomical and hemodynamic data of the fetal heart. The procedure is essential for prenatal diagnosis of cardiovascular abnormalities. In addition, fetal echocardiography is useful to follow-up the progression, monitoring during treatment and making a plan of treatment especially in life-threatening cardiac conditions. The objective of this study was to find the distribution of indications for fetal echocardiography, fetal cardiac anomalies detected, outcome of the fetuses and to assess the accuracy of the procedure. A retrospective study was done at Siriraj Hospital, Mahidol University, Bangkok, Thailand. Pregnant women whose fetuses had prenatal echocardiographic data and gave birth from January 1999 to December 2001 were included. The total number of pregnant women was 54 cases. The indications for fetal echocardiography were suspicion of fetal cardiovascular disease by the obstetrician 42.6 per cent, family history of congenital heart diseases 14.8 per cent, multiple organ system anomalies 14.8 per cent, chromosomal anomalies 11.1 per cent, hydrops fetalis 9.3 per cent, maternal systemic diseases 5.6 per cent and previous pregnancy with a dead fetus in utero 1.9 per cent. The gestational age at the time of the first fetal echocardiography ranged from 17 to 39 weeks (median 28 weeks). The number of fetal echocardiography done in each case ranged from 1 to 10 (median 1.4). Prenatal diagnosis of the abnormal cardiovascular system in fetuses was found in 19 cases (35.2%). There were abnormal cardiac anatomies in 42 per cent, cardiac tumors or abnormal masses in 37 per cent and rhythm disturbances in 21 per cent. When compared with postnatal echocardiography and/or autopsy finding, fetal echocardiography had a sensitivity of 100 per cent, specificity of 96.3 per cent and accuracy of 97.8 per cent.

Conclusion: Fetal echocardiography has good accuracy in the diagnosis of cardiovascular diseases. Obstetrician's suspicion is important in the prenatal diagnosis of heart disease that would have affected the short and long-term outcome of the fetus.