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Fetal echocardiography for early detection of congenital heart diseases

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Abstract

Background

Fetal echocardiography is a complete two-dimensional and Doppler ultrasound evaluation of the human fetal cardiovascular system. It is completely noninvasive, harmless, and also serves as the fetal electrocardiogram.

Aim

To analyze the fetal echocardiographic cases referred to a tertiary cardiac center.

Materials, methods, and results

A total of 478 cases of fetal echocardiograms performed over a period of 5.5 years were compiled and analyzed. Details regarding gestational age, maternal, family history, exposure to teratogens, and reason for referral were recorded. The average gestational age at referral was 24.8 ± 4.6 weeks and maternal age was 24.7 ± 4.3 years. Indications for referrals were abnormal fetal cardiac scan in 128 (26.8 %), previous sibling with congenital heart disease (CHD) in 99 (20.7 %), maternal indications in 87 (18.2 %), echogenic intracardiac focus (EIF) in 87 (18.2 %), high risk in 50 (10.5 %), rhythm problems in 21 (4.4 %), and others (extracardiac malformations) in 6 (1.2 %). In the 87 CHD cases diagnosed, nearly 70 % had complex CHD and 66.7 % were referred only after 22 weeks of gestation. A further 103 cases had EIF, 17 cases had fetal arrhythmia, 3 cases had cardiac masses, and the remaining 268 cases had normal fetal echocardiograms.

Conclusion

Fetal echocardiography can effectively identify abnormal hearts and has enhanced prenatal detection of CHD. The concern in the Indian scenario is the late referrals, lack of follow-up, and financial difficulties, all of which conspire against the chance of the fetus with heart disease getting appropriate treatment.

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Author information

Authors and Affiliations

  1. Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India

    Narasimhan Chitra & I. B. Vijayalakshmi

Authors
  1. Narasimhan Chitra
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  2. I. B. Vijayalakshmi
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Corresponding author

Correspondence to Narasimhan Chitra.

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Conflict of interest

Narasimhan Chitra and I. B. Vijayalakshmi declare that they have no conflict of interest.

Human rights statements and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later revisions. Informed consent was obtained from all patients for being included in the study.

Electronic supplementary material

Below are the links to the electronic supplementary material.

12574_2016_308_MOESM1_ESM.avi

Video 1. Right ventricular outflow view with color comparison showing absent pulmonary valve and color and Doppler showing pulmonary regurgitation and stenosis in a 26 weeks fetus. (AVI 1200 kb)

12574_2016_308_MOESM2_ESM.avi

Video 2. Four-chamber view in a 24 weeks fetus showing single atrium and multiple ventricular septal defects. (AVI 536 kb)

Video 3. Four-chamber view in a 30 weeks fetus showing hypoplastic left ventricle. (MPG 1738 kb)

Video 4. Four-chamber view in a 24 weeks fetus showing hypoplastic right ventricle. (MPG 1974 kb)

12574_2016_308_MOESM5_ESM.avi

Video 5. Four-chamber view in a hydrops 24 weeks fetus showing hugely dilated right atrium with severe tricuspid regurgitation and mitral regurgitation. Stomach is seen in the left thorax, suggesting diaphragmatic hernia. (AVI 1102 kb)

12574_2016_308_MOESM6_ESM.mpg

Video 6. Four-chamber view in a 25 weeks fetus showing Ebstein’s anomaly with severe tricuspid regurgitation. (MPG 465 kb)

12574_2016_308_MOESM7_ESM.avi

Video 7. Four-chamber view in a 35 weeks fetus showing multiple masses in the left ventricle, suggestive of rhabdomyomas. (AVI 1125 kb)

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Chitra, N., Vijayalakshmi, I.B. Fetal echocardiography for early detection of congenital heart diseases. J Echocardiogr 15, 13–17 (2017). https://doi.org/10.1007/s12574-016-0308-2

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  • DOI: https://doi.org/10.1007/s12574-016-0308-2

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