ABSTRACT
BACKGROUND: The impact of early diagnosis of fetal cardiac abnormalities on the postnatal outcome has been controversial in literature. We aimed to evaluate the role of fetal echocardiography (FE) as a diagnostic tool for early detection and proper management of fetal cardiac abnormalities, study the indications of referral and detect the perinatal outcome in our institution. RESULTS: This is a cross-sectional observational and descriptive study that included one hundred and one singleton pregnant women (101 fetuses) who were referred for FE over a period of one year. Indications for referral and perinatal risk factors were documented. FE and postnatal transthoracic echocardiography were done. Fetal cardiac abnormalities were detected in 46.5% of cases. Congenital heart defects (CHDs) in 34.6%, fetal arrythmias in 9.9%, cardiomyopathy in 2.9% and cardiac mass (Rhabdomyoma) in 1% (combined structural and rhythm abnormalities were observed in two fetuses). Of the CHDs, complex heart lesions were diagnosed in 57.1%, common atrioventricular canal in 28.6% and conotrunchal anomalies in 14.3%. Of the ten cases with fetal arrythmias, five fetuses had tachyarrhythmias, four had ectopics and one fetus had congenital heart block in association with maternal lupus. The indications for referral were abnormal obstetric ultrasound (52.5%), maternal medical illnesses (23.8%), multiple neonatal deaths (13.9%) and positive family history of CHD (10.9%). The number of fetuses with cardiac abnormalities was significantly higher than those without cardiac abnormalities in mothers not exposed to perinatal risk factors (p = 0.009) and was statistically lower in mothers exposed to perinatal risk factors (p = 0.005). FE showed 100% accuracy in diagnosing complex lesions, common atrio-ventricular canals, cono-truncal anomalies, cardiac masses and fetal arrhythmias. It missed two cases of tiny muscular ventricular septal defects and one case of aortic coarctation. Cases of fetal supraventricular tachycardia were successfully treated in-utero. CONCLUSIONS: CHDs exist in fetuses with no underlying perinatal risk factors. FE can accurately diagnose most of the cardiac anomalies though few errors remain challenging (aortic coarctation). It also offers a good chance for successful early life-saving management of some types of fetal arrhythmia.
ABSTRACT
BACKGROUND: Congenital heart disease (CHD) is a multifactorial birth defect which has variable demographic characteristics among children in different geographical areas. This study aimed to detect the distribution of demographic data, perinatal risk factors, types, age, and mode of presentation of CHD among Egyptian children. RESULTS: The medical records of 1005 patients were included. They were 545 males (54%) and 462 females (46%) with a ratio of 1.2:1. Acyanotic CHD was encountered in 79.2%. Isolated ventricular septal defect and tetralogy of Fallot were the most common acyanotic and cyanotic lesions, respectively. The majority was diagnosed within the first year of life (86.7%) and was born to young mothers (91.3%). The accidental discovery of a murmur was the most frequent presentation (35%). Heart failure was detected in 44%, audible murmurs in 74.4%, maternal illnesses in 54%, consanguinity in 44.6%, prematurity in 19.3%, assisted reproduction in 11.7%, family history of CHD in 9.2%, abortions in 7.1%, and extracardiac anomalies in 3.6% of the studied population. Down syndrome (DS) was the most commonly occurring chromosomal anomaly, and the atrioventricular septal defect was the most characteristic cardiac lesion found among them. CONCLUSIONS: There is no sex predilection among Egyptian children with CHD. Most of the cases are diagnosed in early infancy. Accidental discovery of a murmur is the most common mode of presentation. A variety of predisposing risk factors are abundant in the Egyptian population. DS is the most common chromosomal anomaly linked to CHD. Establishment of a national medical birth registry containing all information about all births in Egypt is needed for adequate surveillance and monitoring of perinatal health problems and congenital birth defects so that preventive measures can be early implemented. Proper and detailed data collection should be fulfilled in the medical records of every single patient.
ABSTRACT
INTRODUCTION: Recurrent hypoxia makes asthmatics at risk for pulmonary hypertension and ventricular dysfunction. Early stages of these cardiovascular diseases cannot be detected by conventional echocardiography. Tissue Doppler imaging has been introduced recently as a more sensitive and more accurate tool for investigating cardiovascular diseases. OBJECTIVE: Investigating ventricular functions in asymptomatic asthmatic children using tissue Doppler echocardiography. METHOD: Fifty asthmatic children and 50 controls were examined by conventional echocrdiography. Tissue Doppler echocardiography was performed to measure the myocardial performance (Tei) index at the lateral mitral, septal and tricuspid annuli. RESULTS: Septal Tei indices among patients and uncontrolled asthmatics were significantly higher than healthy subjects and controlled asthmatics, respectively (P < 0.05). Septal and tricuspid Tei indices were significantly higher among severe asthmatics and patients with concomitant nasal allergy than those with mild asthma and those without concomitant nasal allergy, respectively (P < 0.05). Septal Tei index correlated negatively with daily inhaled corticosteroid dose (r = -0.412, P = 0.003) and forced expiratory volume in the 1st second/forced vital capacity (r = -0.877, P < 0.001). Lateral Tei index correlated positively with the patient age (r = 0.312, P = 0.027) and duration of asthma (r = 0.359, P = 0.011). CONCLUSION: Tei index can detect subclinical ventricular dysfunction in asthmatics and is affected by asthma duration, control and severity. It can be used for future scoring of asthma severity. Septal annulus seems to be the best location for assessing Tei index in asthmatics.
