Al-Fahham Marwa Moustapha, Gad Nada Ayman, Ramy Ahmed Ramy Mohamed, Habeeb Nevin Mamdouh
Pediatric Department, Pediatric Cardiology Unit, Faculty of Medicine, Ain Shams University, Ramsis Street, Abbasia, Cairo, 11566, Egypt.
Al-Salam International Hospital, Bneid Al Gar, Kuwait City, Kuwait.
Egypt Heart J. 2021 Aug 19;73(1):71. doi: 10.1186/s43044-021-00196-z.
The impact of early diagnosis of fetal cardiac abnormalities on the postnatal outcome has been controversial in literature. We aimed to evaluate the role of fetal echocardiography (FE) as a diagnostic tool for early detection and proper management of fetal cardiac abnormalities, study the indications of referral and detect the perinatal outcome in our institution.
This is a cross-sectional observational and descriptive study that included one hundred and one singleton pregnant women (101 fetuses) who were referred for FE over a period of one year. Indications for referral and perinatal risk factors were documented. FE and postnatal transthoracic echocardiography were done. Fetal cardiac abnormalities were detected in 46.5% of cases. Congenital heart defects (CHDs) in 34.6%, fetal arrythmias in 9.9%, cardiomyopathy in 2.9% and cardiac mass (Rhabdomyoma) in 1% (combined structural and rhythm abnormalities were observed in two fetuses). Of the CHDs, complex heart lesions were diagnosed in 57.1%, common atrioventricular canal in 28.6% and conotrunchal anomalies in 14.3%. Of the ten cases with fetal arrythmias, five fetuses had tachyarrhythmias, four had ectopics and one fetus had congenital heart block in association with maternal lupus. The indications for referral were abnormal obstetric ultrasound (52.5%), maternal medical illnesses (23.8%), multiple neonatal deaths (13.9%) and positive family history of CHD (10.9%). The number of fetuses with cardiac abnormalities was significantly higher than those without cardiac abnormalities in mothers not exposed to perinatal risk factors (p = 0.009) and was statistically lower in mothers exposed to perinatal risk factors (p = 0.005). FE showed 100% accuracy in diagnosing complex lesions, common atrio-ventricular canals, cono-truncal anomalies, cardiac masses and fetal arrhythmias. It missed two cases of tiny muscular ventricular septal defects and one case of aortic coarctation. Cases of fetal supraventricular tachycardia were successfully treated in-utero.
CHDs exist in fetuses with no underlying perinatal risk factors. FE can accurately diagnose most of the cardiac anomalies though few errors remain challenging (aortic coarctation). It also offers a good chance for successful early life-saving management of some types of fetal arrhythmia.
胎儿心脏异常的早期诊断对出生后结局的影响在文献中一直存在争议。我们旨在评估胎儿超声心动图（FE）作为早期检测和妥善管理胎儿心脏异常的诊断工具的作用，研究转诊指征并检测我们机构中的围产期结局。
这是一项横断面观察性描述性研究，纳入了一年内转诊进行FE检查的101名单胎孕妇（101例胎儿）。记录了转诊指征和围产期危险因素。进行了FE检查和产后经胸超声心动图检查。46.5%的病例检测到胎儿心脏异常。先天性心脏病（CHD）占34.6%，胎儿心律失常占9.9%，心肌病占2.9%，心脏肿物（横纹肌瘤）占1%（在2例胎儿中观察到结构和节律异常并存）。在CHD中，复杂心脏病变诊断率为57.1%，房室管畸形占28.6%，圆锥动脉干畸形占14.3%。在10例胎儿心律失常病例中，5例胎儿为快速性心律失常，4例为异位心律，1例胎儿伴有母亲狼疮的先天性心脏传导阻滞。转诊指征为产科超声异常（52.5%）、母亲内科疾病（23.8%）、多次新生儿死亡（13.9%）和CHD家族史阳性（10.9%）。在未暴露于围产期危险因素的母亲中，有心脏异常的胎儿数量显著高于无心脏异常的胎儿（p = 0.009），而在暴露于围产期危险因素的母亲中则在统计学上较低（p = 0.005）。FE在诊断复杂病变、房室管畸形、圆锥动脉干畸形、心脏肿物和胎儿心律失常方面显示出100%的准确性。它漏诊了2例微小肌部室间隔缺损和1例主动脉缩窄。胎儿室上性心动过速病例在宫内得到成功治疗。
在没有潜在围产期危险因素的胎儿中也存在CHD。FE能够准确诊断大多数心脏异常，尽管仍有一些错误具有挑战性（主动脉缩窄）。它也为某些类型胎儿心律失常的成功早期挽救生命管理提供了良好机会。
