Retrospective analysis of prenatal echcardiography findings in cases of congenital heart defects: comparison with postnatal pulmonary hypertension revealed by lungs histopathology (2010-2015)

Abstract

Introduction: It was retrospective analysis of prenatal echocardiography findings in fetuses with congenital heart defects, who died in our institution and had an autopsy exams in years 2010 - 2015. Material and methods: Among total 115 deaths the pulmonary hypertension based on histopathology criteria was present in 83 cases (72%) as a leading cause of their deaths. Out of 83 neonates 40 underwent prenatal echo, 43 did not, however in both groups there were similar types of heart defects. Results: The prenatal echo findings from study group (n=40), from the last echo before the delivery were compared with control group and group of HLHS who did survive neonatal surgery and were discharged from hospital. There were statistical differences between pulmonary artery/aorta ratio in fetuses in control group and fetuses in study group („pulmonary hypertension” after birth) (p=0,044). There were statistical differences between pre-delivery pulmonary artery/aorta ratio in fetuses in study group (with „pulmonary hypertension” after birth) and in group of fetuses with HLHS, alive & well after first surgery (p=0,027). There were no differences between pulmonary artery/ aorta ratio fetuses in control group and fetuses with HLHS, alive & well after first surgery (p=0,38) Conclusion: 1) Pulmonary hypertension was a frequent cause of neonatal deaths among our series of congenital heart defects 2) Dilatation of pulmonary artery (and increased pulmonary/artery ratio ) in fetal echo just before delivery may be an important risk factor for poor neonatal outcome in congenital heart defects.)

Fetal echocardiography in the 3rd trimester of pregnancy as an essential element of modern prenatal diagnostics and perinatal care – recommendations of Polish Society of Prenatal Cardiology 2020

“…The ratio of the main pulmonary artery diameter to that of the ascending aorta was significantly higher in this group of patients than in the control group of healthy neonates. It was also significantly higher than in the case of newborns with heart disease (HLHS) who survived the first stage of cardiac surgery [30,31]. Murlewska et al described a group of 11 newborns with heart defects (such as HLHS, d-TGA, and coarctation of the aorta), in whom the diameter of the pulmonary trunk assessed in the third trimester of pregnancy was greater than the 95 th percentile (equal to or greater than 12 mm).…”

Fetal “Aortic Coarctation” and Different Neonatal Follow-Up in 3 Cases

“…p r e n a t a l cardiology point of view there was severe congenital heart defect 12 , probably CoA , but not critical and due to heart size and dilatation of pulmonary valve 13 respiratory problems were suspected on the 2 nd or 3 rd day after delivery (Fig. 4, 5, 6).…”

“…Emergency cesarean section in case of aneurysm of the muscular intraventricular septum with neonatal follow-up -a case report and review of the literature probability of pulmonary hypertension 13 . Probable in the prenatal life early changes in the pulmonary tissue occurred.…”

Prenatal dilatation of the pulmonary artery in the third trimester – important information for paediatric cardiologist or for neonatologist? Case report

“…• Larger MPA diameter best correlates with postnatal death and respiratory morbidity in CDH • Fetal MPA diameters are probably related to the severity of pulmonary hypoplasia in CDH • PA diameters appeared to be correlated with prognosis in infants with CDH + LH [25,27,43,44] Pulmonary hypertension/HLHS • Enlarged MPA in fetal hypoplastic left heart syndrome • There were statistical differences between PA/AO ratio at 39 weeks of gestation in pulmonary hypertension and HLHS groups [28,43] Coarctation of the aorta-CoA • Fetuses whose PA/Ao is greater than 1.6 are more likely to suffer from CoA [13,16]…”