Clinical utility of fetal echocardiography: an Egyptian center experience

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.

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“…A cross-sectional study on one hundred and one pregnant women in Egypt was done 15 to determine the clinical utility of fetal echocardiography (FE). They performed FE and detected congenital heart defects (CHDs) in 34.6%, of which complex cardiac lesions that were diagnosed, included common atrioventricular canal, cardiac masses, fetal arrhythmias and cono-truncal anomalies.…”

Frontal Lobe Growth impairment in fetuses with congenital heart disease using Ultrasound parameters; A Comparative Cross-sectional study

“…Myelination begins in the third or sixth month of fetal development. The next regions that get myelination are the internal capsule, occipital, splenic, parietal, temporal, frontal, and genu white matter areas 11,12 .…”

A Diagnostic Dilemma: Transposition of the Great Arteries

“…Another important consideration, according to Al-Fahham et al, is the quality of images obtained during the second-trimester standard anomaly scan (SAS), which could play a role in missing these diagnoses [11]. A case-control study found that as opposed to factors such as fetal positioning and maternal body mass index, inadequate adaptational skills when performing the SAS was a more important factor contributing to the missed finding.…”