Population‐based study of antenatal detection of congenital heart disease by ultrasound examination

Abstract

Objectives Ultrasound‐based screening is widely employed for the detection of congenital malformations in utero including congenital heart disease (CHD), but there is widespread variability in the efficacy of screening programs. We aimed to evaluate current antenatal detection rates of selected congenital heart defects in Victoria. Methods Data were collected from the Victorian Perinatal Data Collection Unit and Birth Defects Registry. There were 631 209 births in Victoria (1993–2002), of which 4897 cases had CHD. Cases included live births, stillbirths and termination of pregnancies because of CHD. We reviewed all cases from 1999 to 2002 with atrioventricular septal defect, simple coarctation of the aorta, double‐inlet or ‐outlet ventricle, hypoplastic left heart syndrome, simple transposition of the great arteries (TGA), tetralogy of Fallot and truncus arteriosus. Outcome measures were antenatal diagnosis, pregnancy outcome and associated malformations. Results The overall birth prevalence of CHD from 1993 to 2002 in Victoria was 7.8/1000. The antenatal detection rate for the seven selected defects from 1999 to 2002 was 52.8%. All but 4.8% of the cases had an ultrasound examination at > 13 weeks' gestation. Antenatal detection was highest for hypoplastic left heart syndrome (84.6%) and lowest for simple TGA (17.0%). Conclusions This study shows wide variation in the antenatal detection rate of CHD in Victoria. The low antenatal detection rate of TGA, a defect that should be detected easily, demonstrates suboptimal routine obstetric anomaly scanning. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.

The burden of Fallot’s tetralogy among Nigerian children

“…The finding in the study further confirms the fact that diagnosis of TOF and other congenital heart diseases are usually made between 1-5 years of age in resource-poor countries (20,24,28,29). Late diagnosis of TOF and other CHD in resource-poor countries is due to late presentation, difficulty in assessing specialized care, poverty and poor health seeking behavior (22,23,28,30). The late presentation in this patient is worrisome considering that cyanosis was the commonest indication for echocardiography in these patients; could it be that the parent were not able to recognize bluish discoloration of the lips and tongue (central cyanosis) in these children as abnormal?…”

“…This is late considering that diagnosis of TOF is made in-utero in developed countries. The finding in the study further confirms the fact that diagnosis of TOF and other congenital heart diseases are usually made between 1-5 years of age in resource-poor countries (20,24,28,29). Late diagnosis of TOF and other CHD in resource-poor countries is due to late presentation, difficulty in assessing specialized care, poverty and poor health seeking behavior (22,23,28,30).…”

Cardiopatias Congénitas Complexas: Influência do Diagnóstico Pré-Natal

“…Na literatura, estão descritas taxas de DPN de cardiopatias congénitas de 47,3% em França, 49% nos Estados Unidos e 52,8% na Austrália. 7,8,13 Em Portugal, a Direção Geral da Saúde publicou em 2006 um conjunto de indicações para a realização de ecocardiografia fetal, salientando que na generalidade das gravidezes, a realização de uma ecografia do segundo trimestre de qualidade permite identificar a maioria dos fetos que deverão ser submetidos a estudo ecocardiográfico.…”

Prenatal Screening for Major Congenital Heart Disease

“…This classification scheme was based on extensive clinical experience with prenatal screening and fetal echocardiography, previously described postnatal characteristics of the apical 4CV and OFTVs, 35 and similar classification schemes proposed previously by others. 2,15,17,18,20,22,36 Because some forms of CHD, such as coarctation of the aorta (CoA), may legitimately have variable 4CV and OFTV appearances at 18 to 22 weeks' gestation, an additional category of "possibly abnormal" was included in the classification scheme. The classification of expected appearances of the 4CV and OFTVs into 3 categories (definitely normal, possibly abnormal, and definitely abnormal) enabled data to be analyzed under 2 scenarios: an optimistic "best case" scenario, in which possibly abnormal expected findings were classified as abnormal (detectable), and a conservative "worst case" scenario, in which possibly abnormal expected findings were classified as normal (undetectable) ( Table 2).…”