Impact of fetal echocardiography

Abstract

Prenatal diagnosis of congenital heart disease is now well established for a wide range of cardiac anomalies. Diagnosis of congenital heart disease during fetal life not only identifies the cardiac lesion but may also lead to detection of associated abnormalities. This information allows a detailed discussion of the prognosis with parents. For continuing pregnancies, appropriate preparation can be made to optimize the postnatal outcome. Reduced morbidity and mortality, following antenatal diagnosis, has been reported for coarctation of the aorta, hypoplastic left heart syndrome, and transposition of the great arteries. With regard to screening policy, most affected fetuses are in the “low risk” population, emphasizing the importance of appropriate training for those who undertake such obstetric anomaly scans. As a minimum, the four chamber view of the fetal heart should be incorporated into midtrimester anomaly scans, and where feasible, views of the outflow tracts should also be included, to increase the diagnostic yield. Newer screening techniques, such as measurement of nuchal translucency, may contribute to identification of fetuses at high risk for congenital heart disease and prompt referral for detailed cardiac assessment.

Conotruncal anomalies in the fetus: Referral patterns and pregnancy outcomes in a dedicated fetal cardiology unit in South India

“…These results concur with the findings of the studies from the developed world, which suggest that outcomes of fetal CTA are favorable in the absence of significant co-morbid issues, especially in lesions amenable for anatomic correction. [5–811–16] With better awareness about outcomes of anatomic repair, it is possible that more families may opt to undertake planned post-natal care in the future. As reported from previous studies, a strategy of directed deliveries and planned post-natal care could potentially improve the pre-operative condition of these critical CHDs resulting in significant reduction of peri-operative mortality and morbidity.…”

“…[5–16] The overall outcomes after fetal diagnosis of these anomalies has been poor, especially when associated with extra cardiac and genetic anomalies. [5–912] Survival rates after excluding terminations and intra-uterine deaths have ranged from 40-71%.…”

“…[56912] Termination of pregnancy ranged from 30-50% and was decided by factors like complexity of the cardiac diagnosis and associated anomalies. [5–16] Recent studies report that in the absence of associated co-morbidities, the prognosis of isolated CTA primarily depends on the lesion anatomy and is favorable for reparable lesions like TOF and TGA. [611–13] The reported prevalence of genetic anomalies in these fetuses ranges from 11-18% in with a higher prevalence in TOF-PA, TOF-APV and TA.…”

Fetal echocardiography in Lithuania: traditions, significance and problems

“…Fetal heart pathology was diagnosed in 31% of cases up to the 22nd week of gestation. The prenatal detection rate of congenital heart defects in some countries such as France, UK is high (15,16). The differences are shown in Table 2.…”

Evaluation of Fetal Pulmonary Veins During Early Gestation by Pulsed Doppler Ultrasound: A Feasibility Study

“…Despite evidence that early detection of certain heart malformations could lead to improved fetal/neonatal outcomes [3], routine prenatal ultrasound only detects approximately 30 %-50 % of CHD cases [4,5]. While many cardiac abnormalities are missed during routine ultrasound, most of them can be detected by specialized fetal echocardiography in late pregnancy [2].…”