Value of fetal echocardiographic screening for cardiac malformations

ABSTRACT

With advancing technology in ultrasound machines, examination of the fetal heart became available even at 14 weeks gestation. There are many reasons for referral for complete fetal echocardiographic assessment; the most common one is family history of congenital heart disease, while the most productive one is abnormal four chamber view. This study describes the value and accuracy of fetal echocardiographic screening for cardiac malformations in high-risk pregnancies. We studied 270 pregnant ladies who were referred for fetal echocardiography for several reasons e. g. family history of CHD, diabetes mellitus, inadequate or abnormal view of the heart [four chamber or great vessels], the presence of fetal abnormality on obstetric scanning and increased nuchal translucency thickness particularly in the first trimester. Antenatal fetal echocardiographic scanning of the heart was performed and compared with the postnatal one or compared with the histopathological finding of the specimen if termination of pregnancy took place. In cases where chromosomal abnormalities were detected, a chromosomal study was carried out. Our results showed a spectrum, of multiple cardiac abnormalities, both major and minor such as atrioventricular septal defect, hypoplastic left heart, aortic coarctation, large VSD, transposition of great vessels, cardiomyopathy and cardiac tumours. The most productive group of patients were those referred due to abnormal or inadequate four chamber view, the percentage of CHD in this group was 66.6% extended examination of the fetal heart [four chamber view and great vessel view] could detect about 75% of CHD. The percentage of chromosomal abnormalities in case with CHD was 20%. The accuracy of fetal echo is affected by the time during gestation when scanning is performed especially for valvular stenosis, coarctation of the aorta. Scanning in the first trimester is confined to the high risk patient