Ozkutlu Süheyla, Bostan Ozlem Mehtap, Deren Ozgür, Onderoğlu Lütfü, Kale Gülsev, Güçer Safak, Orhan Diclehan
Department of Pediatric Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Anadolu Kardiyol Derg. 2011 Mar;11(2):131-6. doi: 10.5152/akd.2011.033. Epub 2011 Feb 8.
The aim of this study was to evaluate distinguishing the right/left side of the fetus, cardiac axis and position according to the standardized Cordes technique in 20 cases with cardiac malposition.
We studied retrospectively 1536 cases whose fetal echocardiographic examinations were performed between 1999 and 2006 in prenatal cardiology unit. Among these, cardiac malpositions were determined in 20 cases. The cardiac axis and position were determined according to the Cordes technique. All cases were followed-up by serial fetal echocardiograms until birth or intrauterine death occurred. In cases of intrauterine death, an autopsy was performed. After birth, physical and echocardiographic examinations were done and prenatal and postnatal diagnoses were compared.
Of 1536 fetal echocardiograms performed, 144 revealed congenital heart diseases (9.4%), among these cases 20 were diagnosed with cardiac malposition. Of cases with cardiac malposition, 16 had congenital heart disease, and four had extracardiac malformation. There were six cases of isolated dextrocardia, three cases of situs inversus totalis, six cases of situs ambiguous, and one case of situs inversus with isolated levocardia. Of four cases with extracardiac malformations, two cases had mesoposition, one had dextroposition, and one had extreme levoposition. In six cases the autopsy findings were the same as that their prenatal echocardiographic findings. When postnatal echocardiographic results of the remaining cases with cardiac malposition due to congenital heart disease were compared with prenatal diagnoses, the same echocardiographic findings were verified.
The fetal right/left axis must be determined correctly for the accurate diagnosis of cardiac malpositions. Therefore, we recommend that Cordes technique provides a simple and reliable determination of the fetal right/left axis and fetal situs.
本研究旨在根据标准化的科德斯技术，评估20例心脏位置异常胎儿的左右侧别、心脏轴和位置。
我们回顾性研究了1999年至2006年在产前心脏病科进行胎儿超声心动图检查的1536例病例。其中，确定有20例心脏位置异常。根据科德斯技术确定心脏轴和位置。所有病例均通过系列胎儿超声心动图进行随访，直至出生或发生宫内死亡。对于宫内死亡的病例，进行尸检。出生后，进行体格检查和超声心动图检查，并比较产前和产后诊断结果。
在1536例胎儿超声心动图检查中，144例显示先天性心脏病（9.4%），其中20例被诊断为心脏位置异常。在心脏位置异常的病例中，16例有先天性心脏病，4例有心脏外畸形。有6例孤立性右位心，3例全内脏转位，6例内脏位置不明确，1例内脏转位合并孤立性左位心。在4例有心脏外畸形的病例中，2例有中位，1例有右位，1例有极度左位。6例尸检结果与产前超声心动图检查结果相同。将其余因先天性心脏病导致心脏位置异常病例的产后超声心动图结果与产前诊断进行比较时，相同的超声心动图检查结果得到了证实。
为准确诊断心脏位置异常，必须正确确定胎儿的左右轴。因此，我们建议科德斯技术可提供一种简单可靠的胎儿左右轴和胎儿位置的确定方法。
