Development of prenatal diagnostics of congenital heart defects, profit of standardized scanning planes
Authors:
J. Pavlíček 1; E. Klásková 2; E. Doležálková 3; D. Matura 3; R. Špaček 3; T. Gruszka 1; S. Polanská 1; M. Procházka 4
Authors‘ workplace:
Oddělení dětské a prenatální kardiologie, Klinika dětského lékařství FN a LF OU, Ostrava, přednosta doc. MUDr. M. Hladík, Ph. D.
1; Dětská klinika FN a LF UP, Olomouc, přednosta prof. MUDr. D. Pospíšilová, Ph. D.
2; Gynekologicko-porodnická klinika FN a LF OU, Ostrava, přednosta doc. MUDr. O. Šimetka, Ph. D., MBA
3; Ústav lékařské genetiky FN a LF UP, Olomouc, přednosta prof. MUDr. M. Procházka, Ph. D.
4
Published in:
Ceska Gynekol 2018; 83(1): 17-23
Overview
Objective:
To audit the development and success rate of prenatal detection of congenital heart defects (CHDs), and to evaluate the effectiveness of diagnostics performed in standardized scanning planes.
Setting:
Department of Pediatrics, University Hospital Ostrava.
Design:
Retrospective study.
Methods:
Ultrasound examination of fetal heart (fetal echocardiography) was performed in the second trimester pregnancy. The observed region was the Moravian-Silesian region; the assessment was performed in the retrospective study performed between 2000- 2016. The knowledge of all significant heart defects in the region, processing of data from genetic reporting, further examination of all prenatal pathologies by a pediatric cardiologist, presence of a pediatric cardiologist at all autopsies, with a precise description of the defect, birth of a pathological new-born at a specialized centre. Analysis of detected CHDs was performed in relation to the ultrasound scans used.
Results:
During the monitored 17-year period, a total of 748 (3.8 cases per 1,000 foetuses) of prenatally identified and postnatally significant CHDs were observed in the total population of 198,300 foetuses. There were 53% (393/748) CHDs detected prenatally and 47% (355/748) of cases were not prenatally recognized. The effectiveness of CHD screening has improved progressively, from the initial 10% up to the current 74%. The best results were obtained using the basic four-chamber (4CH) scan; the results in practice gradually decreased, from the basic 4CH projection to the aortic arch.
Conclusion:
The effectiveness of prenatal detection of congenital heart defects gradually improves, namely in cases of hypoplasia and significant ventricular anomalies, with up to 100% prenatally detected cases in the past three years. The level of detection statistically decreases, from the four-chamber projection to out-flow tracts, great arteries and the aortic arch. Congenital heart defect is generally well detectable prenatally, and is usually observed as an isolated anomaly. The most important factors include a precise diagnosis, overall examination of the pregnancy and correct counselling provided for the affected family.
Keywords:
congenital heart defect, fetal echocardiography, screening, ultrasound scan
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Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineArticle was published in
Czech Gynaecology
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