Plesinac Snezana, Terzic Milan, Stimec Bojan, Plecas Darko
Institute of Obstetrics and Gynecology, School of Medicine, University of Belgrade, Serbia.
Int J Fertil Womens Med. 2007 Mar-Jun;52(2-3):89-92.
Ultrasound examination for each and every pregnancy is being accepted as a standard practice worldwide, and prenatal ultrasound diagnosis of congenital heart disease (CHD) is improving due to both staff education and ultrasound equipment modernization. The objective of this study was to estimate the value and accuracy of fetal echocardiography for diagnosis of fetal CHD in a large tertiary referral center for obstetrics and gynecology.
This study was based on a prospective follow-up of 27,051 consecutive patients at the Institute of Ob/Gyn, Belgrade, during 1999-2003. Out of this population a total of 517 (1.9%) patients were selected for fetal echocardiography. The final diagnosis of congenital heart disease was confirmed or rejected on the basis of autopsy and histopathological findings, for the dead fetuses and newborns, or on the basis of neonatal echocardiography (followed by surgery/invasive diagnostic procedure), for the living neonates.
From the total population analyzed, there was 71 gravida (0.26%) with congenital fetal heart disease. In that study group, the most frequent cardiac anomalies were complex congenital heart diseases. Analyzing the outcome, there were 67.6% cases with fetal CHD who delivered live neonates. Out of the 73 fetuses/neonates with CHD, abnormal karyotype was detected in only 9 cases. The parameters of the diagnostic value of fetal echocardiography were as follows: sensitivity 94.4%, specificity 99.8%, positive predictive value 98.5%, negative predictive value 99.1%, and overall diagnostic accuracy 99.0%.
Fetal echocardiography has a very high diagnostic accuracy, commending referral of suspected patients to large tertiary referral centers.
超声检查已成为全球各地每次妊娠的标准检查方法，并且由于工作人员培训和超声设备的现代化，先天性心脏病（CHD）的产前超声诊断正在不断改进。本研究的目的是评估在一家大型妇产科三级转诊中心，胎儿超声心动图对胎儿CHD的诊断价值和准确性。
本研究基于对1999年至2003年期间贝尔格莱德妇产科研究所连续27,051例患者的前瞻性随访。在这一人群中，共有517例（1.9%）患者接受了胎儿超声心动图检查。对于死胎和新生儿，根据尸检和组织病理学结果确诊或排除先天性心脏病；对于存活的新生儿，则根据新生儿超声心动图（随后进行手术/侵入性诊断程序）确诊或排除。
在分析的总人群中，有71例孕妇（0.26%）患有先天性胎儿心脏病。在该研究组中，最常见的心脏异常是复杂先天性心脏病。分析结果显示，患有胎儿CHD的病例中有67.6%分娩出活产新生儿。在73例患有CHD的胎儿/新生儿中，仅9例检测到异常核型。胎儿超声心动图的诊断价值参数如下：敏感性94.4%，特异性99.8%，阳性预测值98.5%，阴性预测值99.1%，总体诊断准确性99.0%。
胎儿超声心动图具有非常高的诊断准确性，建议将疑似患者转诊至大型三级转诊中心。
