Efficacy of fetal echocardiography and an evaluation of indications.

Fetal echocardiography has been accepted as a prenatal noninvasive diagnostic tool of cardiovascular diseases in fetuses for more than three decades. There are limited data in Thailand. A retrospective study of prenatal, natal and postnatal data of pregnant women who had fetal echocardiography at Siriraj Hospital, Bangkok, Thailand, from January 1999 to July 2005 was conducted. In total, there were 117 pregnant women who had fetal echocardiography under standard indications. Median age of pregnant women was 30.2 (17.3-44.2) years old. Median gestational age at the first fetal echocardiography was 29 (17-40) weeks. Median number of time the women had fetal echocardiography was 1 (1-10). Indications for fetal echocardiography were; obstetricians suspected of fetal cardiovascular diseases, multiple anomalies, family history of congenital heart diseases, chromosome anomalies, hydrops fetalis, and other indications (53.8%, 12%, 11.1%, 8.5%, 8.5% and 6.0% respectively). There were 49 (41.8%) cases who had abnormal cardiovascular problems, i.e., structural heart diseases 26 cases, rhythm disturbance 15 cases, and cardiac masses 8 cases. Upon comparison with postnatal echocardiography and/or autopsy findings, fetal echocardiography had a sensitivity of 96.9%, specificity of 90.6%, and accuracy of 92.8%. There was various degrees of risk to have cardiovascular problems for each of the indication taking fetal echocardiography and postnatal data into consideration. Fetal echocardiography had an impact on the management in 57.3% of cases. Conclusion: Fetal echocardiography is a reliable prenatal diagnostic tool for cardiovascular problems with high accuracy and has an impact on the management at prenatal, natal and postnatal period. Different indications for fetal echocardiography have an effect on the relative risk of fetal cardiovascular diseases.

Prenatal diagnosis of cardiovascular diseases.

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.

Congenital coronary arteriovenous fistula in children: A report of 12 cases and review of the literature.

Twelve children, 6 boys and 6 girls, with congenital coronary arteriovenous fistulas were retrospectively studied. The diagnoses were made at ages ranging from 2 days to 9 years. Three (twenty five per cent) of the patients had congestive heart failure, while the others had no symptoms. Abnormal physical findings included bounding pulse 9 cases (75 per cent), continuous murmur 7 case (58 per cent), pansystolic murmur 3 cases (25 per cent), and to and from murmur 2 cases (17 per cent). Cardiomegaly and increased pulmonary vascularity were demonstrated in the chest X-ray in 66 per cent of the patients. Electrocardiograms showed left ventricular hypertrophy in 58 percent of the patients. Provisional diagnoses of small ventricular septal defect, patent ductus arteriosus or catheterization were necessary in making definite diagnoses in which average Qp : Qs was 1.7:1. Three patients (25 per cent) had other associated lesions i.e. patent ductus arteriosus and/or atrial septal defect. Ten patients received surgical treatment with good results.

Total anomalous pulmonary venous connection in Children.

A retrospective analysis of 36 children diagnosed as having total anomalous pulmonary venous connection (TAPVC), admitted to Siriraj Hospital from December 1979 to September 1991, was undertaken. The children, 17 males (47%) and 19 females (53%), ranged in from one day to 13 years. Most cases (63%) presented early within the first year of life. All were normal full-term infants with 86 percent having normal birth weight of large for gestational age (over 2,500 grams). The predominant clinical presentation was mild cyanosis and congestive heart failure with cardiomegaly and increased pulmonary blood flow. Echocardiography and cardiac catheterization were used as diagnostic tools to demonstrate pulmonary venous connection. Cardiac and supracardiac types were the most two common ones (47 and 41%, respectively). Surgical correction was the specific treatment in these patients and the results were good. The total mortality rate was 19 percent, the most common cause of death was complicated pulmonary infections. However, chronic heart failure due to surgical obstruction was encountered even through surgical intervention was performed.