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Results of early foetal echocardiography and cumulative detection rate of congenital heart disease

  • David R. Hartge (a1), Jan Weichert (a1), Martin Krapp (a2), Ute Germer (a3), Ulrich Gembruch (a4) and Roland Axt-Fliedner (a5)...

Abstract

Objective

The aim of this study is to evaluate the cumulative detection rate of foetal echocardiography during gestation and in the early neonatal period, with a special emphasis on early foetal echocardiography.

Methods

We conducted a retrospective survey of all singleton pregnancies from 1993 to 2007, with complete sequential echocardiography from 11 plus 0 to 13 plus 6 weeks of gestation. It was mandatory to have at least one foetal echocardiography in the second or third trimester and one postnatally.

Results

Our study included 3521 pregnancies, in which 77 cases were diagnosed with congenital heart disease. Of them, 66 were detected in the first trimester – 11 plus 0 to 11 plus 6 weeks: 22 cases; 12 plus 0 to 12 plus 6 weeks: 23 cases; 13 plus 0 to 13 plus 6 weeks: 21 cases – with an 85.7% detection rate of congenital heart disease in early foetal echocardiography. In the second trimester, seven cases were found, with a detection rate of 9.1%. The third trimester reported two cases, with a detection rate of 2.6%. Postnatally, two (2.6%) cases were detected. The overall in utero detection rate of congenital heart disease was 97.4%.

Conclusions

Foetal echocardiography performed at the time of anomaly screening in the first trimester results in high detection rates of congenital heart disease. Cardiac pathology may evolve, and further examinations at later stages of pregnancy could improve the detection rate of congenital heart disease.

Copyright

Corresponding author

Correspondence to: D. R. Hartge, Department of Prenatal Medicine, University Hospital of Schleswig-Holstein, Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany. Tel: +49 451 500 2138; Fax: +49 451 500 2192; E-mail: dhartge@gmail.com

References

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1.Ferencz, C, Rubin, JD, McCarter, RJ, et al. . Congenital heart disease: prevalence at livebirth. The Baltimore-Washington infant study. Am J Epidemiol 1985; 121: 3136.
2.Meberg, A, Otterstad, JE, Frøland, G, Lindberg, H, Sørland, SJ. Outcome of congenital heart defects-a population-based study. Acta Paediatr 2000; 89: 13441351.
3.Cuneo, BF, Curran, LF, Davis, N, Elrad, H. Trends in prenatal diagnosis of critical cardiac defects in an integrated obstetric and pediatric cardiac imaging center. J Perinatol 2004; 24: 674678.
4.Bonnet, D, Coltri, A, Butera, G, et al. . Detection of transposition of the great arteries in fetuses reduces neonatal morbidity and mortality. Circulation 1999; 99: 916918.
5.Tworetzky, W, McElhinney, DB, Reddy, VM, Brook, MM, Hanley, FL, Silverman, NH. Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome. Circulation 2001; 103: 12691273.
6.Franklin, O, Burch, M, Manning, N, Sleeman, K, Gould, S, Archer, N. Prenatal diagnosis of coarctation of the aorta improves survival and reduces morbidity. Heart 2002; 87: 6769.
7.International Society of Ultrasound in Obstetrics and Gynecology. Cardiac screening guidelines of the fetus: guidelines performing the ‘basicand extended basic’ scan. Ultrasound Obstet Gynecol 2006; 27: 107113.
8.International Society of Ultrasound in Obstetrics and Gynecology. ISUOG consensus statement: what constitutes a fetal echocardiogram? Ultrasound Obstet Gynecol 2008; 32: 239242.
9.Vogel, M, Sharland, GK, McElhinney, DB, et al. . Prevalence of increased nuchal translucency in fetuses with congenital heart disease and a normal karyotype. Cardiol Young 2009; 19: 441445.
10.Rasiah, SV, Publicover, M, Ewer, AK, Khan, KS, Kilby, MD, Zamora, J. A systematic review of the accuracy of first-trimester ultrasound examination for detecting major congenital heart disease. Ultrasound Obstet Gynecol 2006; 28: 57.
11.Gembruch, U, Knöpfle, G, Chatterjee, M, Bald, R, Hansmann, M. First-trimester diagnosis of congenital heart disease by two-dimensional and Doppler echocardiography. Obstet Gynecol 1990; 75: 496498.
12.Gembruch, U, Knöpfle, G, Bald, R, Hansmann, M. Early diagnosis of fetal congenital heart disease by transvaginal echocardiography. Ultrasound Obstet Gynecol 1993; 3: 310317.
13.Bronshtein, M, Zimmer, EZ, Milo, S, Ho, SY, Lorber, A, Gerlis, LM. Fetal cardiac abnormalities detected by transvaginal sonography at 12–16 weeks’ gestation. Obstet Gynecol 1991; 78: 374378.
14.Pandya, PP, Snijders, RJM, Johnson, SP, De Lourdes Brizot, M, Nicolaides, KH. Screening for fetal trisomies by maternal age and fetal nuchal translucency thickness at 10 to 14 weeks of gestation. Br J Obstet Gynaecol 1995; 102: 957962.
15.Smrcek, JM, Berg, C, Geipel, A, et al. . Detection rate of early fetal echocardiography and in utero development of congenital heart defects. J Ultrasound Med 2006; 25: 187196.
16.Gembruch, U. Prenatal diagnosis of congenital heart disease. Prenat Diagn 1997; 17: 12831297.
17.Yagel, S, Cohen, S, Achiron, R. Examination of the fetal heart by five short-axis views: a proposed screening method for comprehensive cardiac evaluation. Ultrasound Obstet Gynecol 2001; 17: 367369.
18.Yagel, S, Weissman, A, Rotstein, Z, et al. . Congenital heart defects. Natural course and in utero development. Circulation 1997; 96: 550555.
19.Allan, LD, Sharland, G, Tynan, MJ. The natural history of the hypoplastic heart syndrome. Int J Cardiol 1989; 25: 341343.
20.Allan, LD, Crawford, DC, Tynan, M. Evolution of coarctation of the aorta in intrauterine life. Br Heart J 1984; 52: 471473.
21.Allan, LD. Development of congenital lesions in mid- or late gestation. Int J Cardiol 1988; 19: 361362.
22.Axt-Fliedner, R, Kreiselmaier, P, Schwarze, A, Krapp, M, Gembruch, U. Development of hypoplastic left heart syndrome after diagnosis of aortic stenosis in the first trimester by early echocardiography. Ultrasound Obstet Gynecol 2006; 28: 106109.
23.Axt-Fliedner, R, Hartge, D, Krapp, M, et al. . Course and outcome of fetuses suspected of having coarctation of the aorta during gestation. Ultraschall Med 2009; 30: 269276.
24.Head, CE, Jowett, VC, Sharland, GK, Simpson, JM. Timing of presentation and postnatal outcome of infants suspected of having coarctation of the aorta during fetal life. Heart 2005; 91: 10701074.
25.Marasini, M, DeCaro, E, Pongiglione, G, Ribaldone, D, Caponetto, S. Left heart obstructive disease: changes in the echocardiographic appearance during pregnancy. J Clin Ultrasound 1993; 21: 6568.
26.Simpson, JM, Sharland, GK. Natural history and outcome of aortic stenosis diagnosed prenatally. Heart 1997; 77: 205210.
27.Hornberger, LK, Sanders, SP, Rein, AJJT, Spevak, PJ, Parness, IA, Colan, SD. Left heart obstructive lesions and left ventricular growth in the mid-trimester fetus. A longitudinal study. Circulation 1995; 92: 15311538.
28.Fishman, NH, Hof, RB, Rudolph, AM, Heymann, MA. Models of congenital heart disease in fetal lambs. Circulation 1978; 58: 354364.
29.Hornberger, LK, Sahn, DJ, Kleinman, CS, Copel, J, Silverman, NH. Antenatal diagnosis of coarctation of the aorta: a multicenter experience. J Am Coll Cardiol 1994; 23: 417423.
30.Hornberger, LK, Sanders, SP, Sahn, DJ, et al. . In utero pulmonary artery and aortic growth and potential for progression of pulmonary outflow tract obstruction in tetralogy of Fallot. J Am Coll Cardiol 1995; 25: 739745.
31.Smrcek, JM, Berg, C, Geipel, A, Fimmers, R, Diedrich, K, Gembruch, U. Early fetal echocardiography: heart biometry and visualization of cardiac structures between 10 and 15 weeks’ gestation. J Ultrasound Med 2006; 25: 173182.
32.Hyett, JA, Perdu, M, Sharland, GK, Snijders, RS, Nicolaides, KH. Increased nuchal translucency at 10–14 weeks of gestation as a marker for major congenital heart defects. Ultrasound Obstet Gynecol 1997; 10: 242246.
33.Makrydimas, G, Sotiriadis, A, Huggon, IC, et al. . Nuchal translucency and fetal cardiac defects: a pooled analysis of major fetal echocardiography centers. Am J Obstet Gynecol 2005; 192: 8995.
34.Mavrides, E, Cobian-Sanchez, F, Tekay, A, et al. . Limitations of using first-trimester nuchal translucency measurement in routine screening for major congenital heart defects. Ultrasound Obstet Gynecol 2001; 17: 106110.
35.Matias, A, Gomes, C, Flack, N, Montenegro, N, Nicolaides, KH. Screening for chromosomal abnormalities at 10–14 weeks: the role of ductus venosus blood flow. Ultrasound Obstet Gynecol 1998; 12: 380384.
36.Matias, A, Huggon, I, Areias, JC, Montenegro, N, Nicolaides, KH. Cardiac defects in chromosomally normal fetuses with abnormal ductus venosus blood flow at 10–14 weeks. Ultrasound Obstet Gynecol 1999; 14: 307310.

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