Diagnosis and Treatment of Fetal Cardiac Anomalies

ABSTRACT

PURPOSE: Fetal echocardiography is used for the prenatal diagnosis of congenital heart disease. Fetal echocardiography allows decisions to be made in advance where the fetal abnormality is not compatible with life after delivery or where early correction is required. Our fetal echocardiographic experience was analysed retrospectively to guide future clinical application. METHODS: 138 mothers had fetal echocardiography from April 1992 to December 1995. Their echo findings were recorded on VHS video tape. We followed up the infant after delivery. Data was collected from obstetric outpatient records and admission records, pediatric admission records and outpaitent records. RESULTS: 1)138 mothers had fetal echocardiography. Serious heart disease was found in 9 cases with a detection rate of 6.4%. Average age of the mother was 28.9+/-4.2 years (range 17-44 years). Average gestational period was 24.0+/-5.1 weeks(range 10-36 weeks). 2)Indications for fetal echocardiography were as follows; maternal factors 77 cases, including 34 cases of alpha fetoprotein abnormality. fetal factor 32 cases including 18 cases of arrhythmia, genetic factors 29 cases, including 26 cases of family history of congenital heart disease. 3)Serious cardiac anomalies were 5 cases. Serious arrhythmia were present in 4 cases(Total 9 cases with detection rate of 6.5%). Mild arrhythmia was detected in 7 cases(5.1 %). 4)The serious cardiac anomalies were mitral hypoplasia, right atrial tumor, AVSD, TOF and VSD. 5)The Serious arrhythmia were complete atrioventricular block 1 case, second degree atrioventricular block 1 case, transient cardiac arrest 1 case and atrial flutter 1 case. 6)The Mild arrhythmia were premature atrial contraction 4 cases and premature ventricular contraction 3 cases. 7)The non-cardiac anomalies were one case of hydrocephalus, cerebral arteriovenous fistula, diaphragmatic hernia, agenesis of right kidney, sacrococcygeal teratoma, fetal ascites and 4p-syndrome. There were 2 cases of spontaneous abortion without definite anomaly. During the study period, there were 8 terminations of pregnancy including 3 cases of spontaneous abortion. 8) 105 infants were followed up after birth. 25 cases were missing. CONCLUSIONS: Most of the congenital heart disease confirmed by fetal echocardiography was predicted by antenatal ultrasound. Most of the fetal echocardiography was performed to confirm the congenital heart diseas when any of the fetal abnoramlities were found. In some of the treatable heart disease, especially like fetal arrhythmia, maternal adminstration of adequate medication make a good treatment results.