Ecocardiografia fetal

Abstract

Background. Fetal echocardiography (FEC) allows for the intrauterine evaluation of cardiac structure and function. Objective. To report the experience in FEC at Hospital Materno-Infantil Vall d'Hebron (Barcelona), with particular reference to: indications; diagnoses; attitudes towards pregnancy continuation; and diagnostic errors. Method. Retrospective analysis of the results of FEC studies obtained consecutively from January 1992 to January 1998. Definitive information, from fetal necropsy or newborn echocardiography, was available in every case with an abnormal FEC. Results. 586 FEC were obtained from 485 pregnancies (minimum of one study per fetus and maximum of 6). Indications were: family history of congenital cardiac defect (37%); cardiac anomaly (27%) or presence of dismorphologic signs (19%) suspected in previous fetal echocardiography; and arrhythmia in other previous examinations (17%). IN 151 cases some anomaly was detected, with arrhythmia being the most frequent (33 cases). Single ventricle (15), atrioventricular defect (11), d-transposition of great arteries (10) and left ventricle hypoplasia (10), were the structural cardiac defects detected more frequently. Sixteen parents, from cases where legal interruption of pregnancy (LIP) was possible, chose to end gestation. In all these cases fetal necropsy confirmed FEC findings. From the remaining 135 fetuses, postnatal echocardiography only identified 4 diagnostic errors. Conclusions. FEC is a useful tool for the prenatal diagnosis of cardiac defects. It allows for objective support when LIP is decided by parents, and for proper assistance of the newborn when pregnancy is left uninterrupted. Notwithstanding, diagnostic errors, while infrequent, are always a possibility.