We describe the results of routine obstetric ultrasound examination over a period of 22 years (1970-91) at the Institut Universitari Dexeus, Barcelona, Spain. A total of 1006 malformed fetuses or neonates were identified at abortion or delivery. The prevalence of fetal abnormalities was 3.03%. Fetal anomalies were diagnosed antenatally in 788 (78.33%) cases. Early prenatal diagnosis (before 22 weeks of gestation) was made in 598 (59.44%) cases. The detection of malformed fetuses increased from 19.75% in the first phase of the study (1970-74) to 96.33% in the last phase (1990-91). The specificity of the method was over 99% throughout the study period. The most frequently diagnosed anomalies were urinary tract anomalies (22.86% of cases), followed by head and neck anomalies (18.68%), musculoskeletal anomalies (8.64%), heart anomalies (7.35%) and gastrointestinal anomalies (7.35%). The earliest diagnosed malformations were those of the thoracoabdominal wall (81.08%), followed by defects of the urinary tract (70.86%) and of the diaphragm (70.83%).

SUMMARY Seventeen cases are described in which both atria connect directly to a chamber with right ventricular characteristics. The atria connected through separate atrioventricular valves in six hearts and a common valve in 11. All hearts had a posterior rudimentary chamber. The septum which separated it from the main chamber was directed to the crux of the heart. Ten hearts were from patients with atrial situs solitus and seven from patients with atrial situs ambiguus. Arterial connections were concordant in three cases, had a double outlet from the main ventricular chamber in nine and single outlet of the heart in five. The patent artery always arose from the main chamber, with pulmonary atresia in three and aortic atresia in two.This and other studies indicate that double inlet atrioventricular connection does not predict the morphology of the main chamber. Although usually associated with a main chamber of left ventricular type, it may also be associated with a main chamber having right ventricular characteristics. Both types should be considered as univentricular hearts; the posterior chamber in hearts of right ventricular type are analogous to the anterior chamber in univentricular hearts of left ventricular type and are a rudimentary chamber rather than a hypoplastic ventricle. In the right ventricular form of univentricular heart, the trabecular zone of the rudimentary chamber is of left ventricular type. Materials and Methods During examination of autopsy specimens from five centers, we discovered 17 hearts in,which both atria communicated via two separate valves or a common atrioventricular valve, with a ventricular chamber with right ventricular characteristics. Six were from the Hospital for Sick Children, London; five were from the Brompton Hospital, London; three were from the Royal Liverpool Children's Hospital; two were from Newcastle General Hospital; and one was from Killingbeck Hospital, Leeds. Each heart was examined morphologically, and four hearts were sectioned to identify the position of the conducting tissue (Wilkinson JL, Dickinson DF, Smith A, Anderson RH: submitted for publication). During our study we found that both valves did not have to be committed entirely to the chamber of right ventricular morphology. We also noted a spectrum, as described by others,3 between these hearts and hearts with straddling mitral valves. In this study, therefore, we included only hearts in which one complete valve, and more than half a straddling valve, were committed to the chamber with right ventricular trabecular pattern. In some of the hearts with a common atrioventricular orifice, the entire orifice was committed to the main chamber. These were included in the series. In other hearts we could discern distinct mitral and tricuspid components of the common valve by virtue of the attachments of the valve leaflets to the septum. In these latter specimens, the mitral component was hypoplastic, but was committed to a hypoplastic left ventricular chamber. These hearts were not included in the univentri...

Euploid fetuses with increased nuchal translucency thickness have a significantly increased risk of cardiac defects. This is a marker of different types of heart anomalies and constitutes an additional indication for targeted fetal echocardiography. Most of the cardiac defects can be detected by fetal echocardiography.

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Reversed end‐diastolic umbilical artery velocities and a reduced chorionic sac were first seen at 10 weeks in a pregnancy subsequently showing a normal male karyotype on chorionic villi. Four weeks later Doppler studies demonstrated normal umbilical artery waveforms. At 20 weeks, ultrasound examination of the fetus revealed a mild pericardic effusion, hypoplastic right heart with hypertrophic myocardium and a single umbilical artery, suggesting pulmonary atresia. After neonatal death, pathological studies confirmed pulmonary atresia. This case suggests that reversed end‐diastolic umbilical flow in the first trimester may identify a subgroup of fetuses with a lethal abnormality (heart defect, severe intra‐uterine retardation, aneuploidy or others). Copyright © 1998 John Wiley & Sons, Ltd.

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