Fetal Cardiomegaly: Echocardiographic Findings and Outcome in 19 Cases

Abstract

The echocardiographic findings and clinical courses in 19 fetuses with marked cardiomegaly [heart length, width, area, cardiothoracic ratio, heart/thoracic area (CTA) ratio > 2 SD] were reviewed. An abnormal heart was the reason for referral in 16 cases of 19 (84.2%). The mean gestational age was 31.5 weeks at detection. Intracardiac hemodynamics were studied using pulsed, color, and M-Mode color Doppler. Despite the heterogeneous etiology of marked cardiomegaly (5 Ebstein’s anomalies, 5 tricuspid valve dysplasias, 3 dilatative cardiomyopathies and 6 miscellaneous) a holosystolic tricuspid regurgitation with right atrial enlargement was found in 17 of the 19 cases (89.4%) as a common pathogenetic feature. A hydrops was found in 10 cases (52.6%). Besides 1 elective legal abortion, a high mortality rate of 83.3% was observed in the group followed up (6 intrauterine and 9 neonatal deaths). Among the cardiac measurements the CTA ratio seemed to correlate with fetal outcome, since all three survivors had the lowest values and all fetuses with CTA ratio > 0.6 showed a lung hypoplasia as a sequel of compression by cardiac enlargement. The presence or the development of hydrops, an obstruction of the right ventricular outflow tract, and the lung hypoplasia could be considered as signs of poor prognosis. A reliable differentiation between a patent pulmonary valve, pulmonary stenosis and pulmonary atresia in severe tricuspid regurgitation using modern Doppler means is difficult as seen in our studied group and in the literature. A cardiomegaly could be detected by nonexperienced examiners, but even if its presentation in fetal life could be considered as one of the main predictors of poor outcome, such cases have to be referred to centres experienced in fetal echocardiography.

Increased Nuchal Translucency in a Case of Long-Chain 3-Hydroxyacyl- Coenzyme A Dehydrogenase Deficiency

“…Most probably the reason for the severe hydrops fetalis in the third trimester was a primary or secondary cardiac dysfunction. This observation is in accordance with the results of Chaoui et al [28]. The mean time for detection of cardiomegaly in their study group was 31.5 weeks and is in agreement with former studies [29,30].…”

Fetal echo cardiography: the state of the art of the state of the heart

“…Reports emerged on pulmonary arterial and venous flow, on measurements across the fetal shunts such as the ductus arteriosus and foramen ovale, and even on the coronary artery and venous systems 37,[41][42][43][44][45][46][47][48][49][50] . The quantification of tricuspid valve insufficiency was shown to reveal valuable information on etiology and prognosis [51][52][53][54] . The pathological conditions investigated are no longer confined to fetal heart defects but have expanded to include other fetal conditions involving the cardiovascular system.…”

Sonographische Messungen der Durchmesser der Aorta und des Truncus pulmonalis beim Feten

“…So kann z.B. eine Aortendilatation beim Feten ein Hinweis für eine Fallot-Tetralogie, einen Tnincus arteriosus communis oder ein Marfan-Syndrom sein [3,11,13,19,20], Eine (kompensatorisch) diktierte Pulmonalklappe findet man oft bei Feten mit einem hypoplastischen Linksherzsyndrom (HLHS). Die Aor tenklappe ist nicht nur bei diesem Herzfehler auffallend schmal, sondern nach neueren Untersuchungen von Hornberger et al [14] auch bei der Aortenisthmussteno se.…”

“…Die Aor tenklappe ist nicht nur bei diesem Herzfehler auffallend schmal, sondern nach neueren Untersuchungen von Hornberger et al [14] auch bei der Aortenisthmussteno se. Ein schmaler TP-Durchmesser kann ein Hinweis auf eine Pulmonalatresie sein [21], wobei hier mit falsch positiven und falsch-negativen Befunden zu rechnen ist [20,22], Cartier und Doubilet [12] sowie Veille und Sivakoff [17] untersuchten weiterhin die Bedeutung der AO-und TP-Durchmesser bei Feten mit einer intrauteri nen Wachstumsretardierung und fanden bezogen auf das Gestationsalter keine Unterschiede zum Normalkollek tiv.…”