Meyer-Wittkopf M, Cooper S, Sholler G
New South Wales Fetal Cardiac Service, Adolph Basser Cardiac Institute, Royal Alexandra Hospital for Children, Westmead, Sydney, Australia.
Ultrasound Obstet Gynecol. 2001 May;17(5):392-7. doi: 10.1046/j.1469-0705.2001.00381.x.
To assess the level of agreement between obstetric and pediatric cardiologist sonographers' diagnosis of fetuses with suspected congenital heart disease and to compare this with the final postnatal diagnosis.
We retrospectively reviewed the notes of 1037 patients undergoing fetal echocardiography over a 5-year period (1995-99) at the principal tertiary referral center for fetal cardiology in New South Wales, Australia. The median gestational age at presentation was 21 weeks (range 17-38) with 49% of the scans performed at < 21 weeks and a further 17% performed at 21-24 weeks. The accuracy of the fetal cardiac diagnosis was validated by neonatal cardiac investigation or autopsy.
A total of 249 cases of congenital heart disease were identified antenatally during this 5-year period with the majority (84%) referred because of suspicion of a cardiac malformation during an obstetric scan. Of the 268 fetuses with congenital heart disease suspected by obstetric sonographers, 209 had confirmed cardiac defects. Complete correlation between obstetric sonographers' and pediatric cardiologists' prenatal cardiac findings was achieved in 62% of cases. There were major differences involving the atrioventricular morphology in 18% of cases and the outflow tract anatomy in 20%. Complete agreement between prenatal and postnatal diagnosis in fetuses with complex congenital heart disease was achieved in 59% of cases for obstetric sonography (17% false positive; 41% false negative) and 95% for fetal echocardiography by pediatric cardiologists (2% false positive; 5% false negative).
Improved accuracy in diagnosis can be achieved through a pediatric cardiologist with special skills in fetal echocardiography working collaboratively with obstetric sonographers to optimize the details of diagnosis. This may influence management and counseling.
评估产科和儿科心脏病专家超声医师对疑似先天性心脏病胎儿的诊断一致性水平，并将其与产后最终诊断结果进行比较。
我们回顾性分析了澳大利亚新南威尔士州胎儿心脏病主要三级转诊中心在5年期间（1995 - 1999年）接受胎儿超声心动图检查的1037例患者的病历。就诊时的中位孕周为21周（范围17 - 38周），其中49%的扫描在<21周时进行，另有17%在21 - 24周时进行。胎儿心脏诊断的准确性通过新生儿心脏检查或尸检进行验证。
在这5年期间，共产前诊断出249例先天性心脏病，其中大多数（84%）是因为产科扫描怀疑心脏畸形而转诊。在产科超声医师怀疑患有先天性心脏病的268例胎儿中，209例确诊有心脏缺陷。产科超声医师和儿科心脏病专家的产前心脏检查结果在62%的病例中完全一致。18%的病例在房室形态方面存在重大差异，20%在流出道解剖方面存在重大差异。对于复杂先天性心脏病胎儿，产科超声检查的产前与产后诊断完全一致的比例为59%（假阳性17%；假阴性41%），儿科心脏病专家的胎儿超声心动图检查为95%（假阳性2%；假阴性5%）。
通过具备胎儿超声心动图特殊技能的儿科心脏病专家与产科超声医师合作，优化诊断细节，可提高诊断准确性。这可能会影响管理和咨询工作。
