Ozbarlas Nazan, Erdem Sevcan, Küçükosmanoğlu Osman, Seydaoğlu Gülşah, Demir Cansun, Evrüke Cüneyt, Tuncay Özgünen Fatma
Department of Pediatric Cardiology, Faculty of Medicine, Çukurova University, Adana, Turkey.
Anadolu Kardiyol Derg. 2011 Mar;11(2):125-30. doi: 10.5152/akd.2011.032. Epub 2011 Feb 8.
To establish and compare the frequency of intrauterine congenital heart defects in high-risk and low-risk pregnancies for congenital heart diseases.
Records of 3782 patients who underwent fetal echocardiography at the Pediatric Cardiology Unit were reviewed for reasons of referral and results of echocardiography retrospectively. The categorical variables between the groups were analyzed using a Chi-square test.
Structural heart defects were found in 213 (5.6%) fetuses in both high and low risk groups. Most common defects were ventricular septal defect (36.2%) and atrioventricular septal defect (14.1%). Frequency of congenital heart diseases was 7.8% (169 fetuses) in high-risk group: 4.1% were complex, 2.3% significant and 1.4% were minor. In low-risk group, the frequency was 2.7% (44 fetuses): 0.6% were complex, 0.8% significant and 1.3% were minor. In this group, rates of congenital defects were high regarding particular reasons: intrauterine fetal death in previous pregnancy (6.3%), abnormal first or second trimester screening tests (4.3%), and multiple gestations (3.4%). The sensitivity and specificity of fetal echocardiography according to transthoracic echocardiography were found to be 86% and 99%, respectively.
Congenital heart diseases rate, as expected, was found to be higher in high-risk group. However, regarding intrauterine fetal death in previous pregnancy, abnormal first or second trimester screening tests and multiple gestation, no statistically significant difference was observed between low-risk and high-risk groups. Therefore, we suggest the routine use of fetal echocardiography in cases we have mentioned above if the staff and equipment of the pediatric cardiology clinic are eligible.
确定并比较先天性心脏病高危妊娠和低危妊娠中宫内先天性心脏缺陷的发生率。
回顾性分析在儿科心脏病科接受胎儿超声心动图检查的3782例患者的转诊原因及超声心动图检查结果。采用卡方检验分析两组间的分类变量。
高危组和低危组中均有213例（5.6%）胎儿发现结构性心脏缺陷。最常见的缺陷是室间隔缺损（36.2%）和房室间隔缺损（14.1%）。高危组先天性心脏病的发生率为7.8%（169例胎儿）：复杂型占4.1%，显著型占2.3%，轻微型占1.4%。低危组发生率为2.7%（44例胎儿）：复杂型占0.6%，显著型占0.8%，轻微型占1.3%。在该组中，因特定原因先天性缺陷的发生率较高：既往妊娠中有宫内胎儿死亡（6.3%）、孕早期或孕中期筛查试验异常（4.3%）以及多胎妊娠（3.4%）。经胸超声心动图检查显示胎儿超声心动图的敏感性和特异性分别为86%和99%。
正如预期的那样，高危组先天性心脏病的发生率更高。然而，对于既往妊娠中有宫内胎儿死亡、孕早期或孕中期筛查试验异常以及多胎妊娠的情况，低危组和高危组之间未观察到统计学上的显著差异。因此，我们建议，如果儿科心脏病诊所的人员和设备符合条件，在上述情况下常规使用胎儿超声心动图。
