Abstract 16150: Early Fetal Echocardiography of High Risk Patients: A Cardiac Referral Center Experience
Objective: To evaluate the experience of diagnosing cardiac anomalies using early fetal echocardiography at a large pediatric cardiac referral center. Study Design: Retrospective study of all early fetal echocardiograms, (<17 weeks estimated gestational age (EGA)), performed between July 2007 and December 2010. Echocardiograms and medical records were reviewed. Characteristics of diagnoses modified at follow-up evaluation were analyzed.
Results: There were 151 studies performed on 142 fetuses. Mean initial EGA was 14.5 weeks. Transabdominal imaging was sufficient for 104; 38 required transvaginal imaging (all <15 weeks EGA). Cardiac disease was found in 32 (20.4%). High yield indications were suspected cardiac anomalies by ultrasound (91.7%) and extracardiac anomalies (50%). Lower yield indications were family history (6.1%) and increased nuchal translucency (13.8%). No fetuses referred for advanced maternal age or maternal diabetes had cardiac disease. Follow-up evaluation at >20 weeks EGA was possible in 128 fetuses (10 terminated, 4 lost to follow-up), 19 of which had a cardiac anomaly at initial study. At follow-up evaluation, 3 fetuses initially diagnosed with a cardiac anomaly had normal hearts, but no fetuses initially diagnosed as normal had cardiac disease (sensitivity 100%, specificity 97.3%, positive predictive value 84.2%, negative predictive value 100%). Seven fetuses had modification of the original diagnoses at follow-up; 3 were initially described as having possible septal defects not seen at mid-gestation, 2 had slightly changed diagnoses, and 2 had disease progression different than predicted.
Conclusion: Early fetal echocardiography is feasible and can accurately identify significant cardiac anomalies. Lesions that may not be detected with accuracy include septal defects and diseases that progress throughout gestation. Early fetal echocardiography should always be followed by a comprehensive cardiac evaluation at 18-22 weeks EGA to maximize detection and accuracy of diagnosis.
- © 2011 by American Heart Association, Inc.