medigraphic.com
Federación Mexicana de Ginecología y Obstetricia, A.C.

2006, Number 12

<< Back Next >>

Ginecol Obstet Mex 2006; 74 (12)

Diagnostic and frequency of fetal heart disease by echocardiography in pregnancies with high-risk factors

Hinojosa CJC, San Luis MR, Veloz MMG, Puello TE, Arias MLG, Barra UA, Cetina CNPS, Ángel GG, Gutiérrez GGA, Ramos GRA, Santos VI

Language: Spanish
References: 45
Page: 645-656
PDF size: 374.74 Kb.


ABSTRACT

Background: Fetal heart diseases are increasingly frequent. These are part of birth defects and, therefore, appear in early phases of the gestation. Diagnosis or early detection of functional and structural abnormalities of the heart allows to the obstetrician and the pediatric cardiologist to plan, in a timely manner, the treatment and prenatal and postnatal monitoring with the purpose of preventing complications.
Objective: To determine the types and frequencies of heart diseases in pregnancies with high-risk factors.
Patients and method: It was analized an observational, descriptive and retroprolective series of cases. From January 2003 to June 2006, fetal echocardiograms were made in women with pregnancies longer than 15 weeks and with high-risk factors. At childbirth was made a cardiovascular evaluation. Analysis was carried out through descriptive statistics.
Results: maternal age average was of 27.3 ± 6.8 years; gestational age was of 31 ± 5 weeks. In total, there were carried out 275 fetal echocardiograms (FE) in 208 patients; in 56 of them, was made one fetal ecocardiogram, two in 37 and three in 15. Risk factors of reference to the specialized medical unit were: abnormalities detected through obstetrical ultrasound (35.1%), tachycardia-bradycardia-arrhythmia (29.8%), probable chromosomic anomalies (13.9%), oligohydramnios or polyhydramnios (4.8%), familiar antecedents of congenital heart diseases (3.8%), others (12.6%). Heart disease was diagnosed by fetal echocardiogram in 55 patient (26.4%): unique ventricle (n=5), hypoplastic right ventricle (n=3), hypoplastic left ventricle (n=4), congenital complete heart block (n=1), Ebstein and dysplasia of the mitral and tricuspid valves (n=12), tumor (n=5), ectopia cordis (n=2), auriculoventricular channel (=1), supraventricular tachycardia (n=4), supraventricular extrasystole (n=3) and other. Diagnosis was confirmed at childbirth in 99.5% of the cases. The treatment was initiated in uterus for arrhythmia and cardiac insufficiency in 19 patients. The patients with high-risk cardiopathy (at birth) were evaluated at beginning through specialized cardiological treatment and then they were transferred to the service of pediatric cardiology.
Conclusions: Frequency of fetal heart diseases in patients with high-risk factors is of 25.4%. In these patients, the fetal echocardiogram (prenatal and postnatal) allows planning the optimal cardiological and obstetric treatment as well as to inform to the relatives.


REFERENCES

  1. Park M. Cardiología Pediátrica. Manuales Prácticos. 2a ed. Madrid: Mosby, 1999.

  2. Farrú O. En la ruta del progreso cardiológico. Rev Pediatría 2000;43:67-68.

  3. Hernández I. Editorial. Rev Peditría 1996;30:3.

  4. Farrú O. Cardiopatías congénitas: aspectos epidemiológicos, genéticos y pronósticos. Rev Pediatría 1996;39:5-11.

  5. Hoffman JI, Christianson R. Congenital heart disease in a cohort of 19,502 births with long-term follow-up. Am J Cardiol  1978;42(4):641-7.

  6. Kachalia P, Bowie JD, Adams DB, Carrol BA. In utero appearance of the atrial septum primum and septum secundum. J Ultrasound Med 1991;10:423-6.

  7. Allan LD, Lockhart S. Intrathoracic cardiac position in the fetus. Ultrasound Obstet Gynecol 1993;3:93-6.

  8. Papp Z, Toth-Pal E, Papp C, Toth Z, et al. Impact of prenatal mid-trimester screening of the prevalence of fetal structural anomalies: a prospective epidemiological study. Ultrasound Obstet Gynecol 1995;6:320-6.

  9. Rustico MA, Bennetoni A, D´Ottavio, Maieron A, et al. Fetal heart screening in low-risk  pregnacies. Ultrasound Obstet Gynecol 1995;6:313-9.

  10. De Vore G, et al. Fetal echocardiography: Factor that influence imaging of the fetal heart during the second trimester of pregnancy. J Ultrasound Med 1993;12:659-63.

  11. De Vore G. The Fetus with cardiac arrhythmias.  The unborn patient.  2nd ed. W.B. Saunders Company, 1991.

  12. Jaeggi ET, Sholler GF, Jones OD, Cooper SG. Comparative analysis of pattern, management and outcome of pre- versus postnatally diagnosed major congenital heart disease: a population-based study. Ultrasound in Obstet Gynecol 2001;17:380-5.

  13. Allan J, Benacerraf B, Copel JA, Carvalho JS, et al. Isolated major congenital heart disease. Ultrasound Obstet Gynecol 2001;17(5):370-9.

  14. Henry WL, DeMaria A, Gramiak R, King DL, et al. Report of the American Society of Echocardiography committee on nomenclature and standards in two-dimensional echocardiography. Circulation 1980;62:212-7.

  15. Pérez-Ramírez M, Estévez-Muguercia R, Pérez-Ramírez R, Fuentes-Real D. Embarazo y enfermedades cardiovasculares. Obstet Ginecol 1998:13-9.

  16. Pérez Ramírez M, Fernández Fernández I, Mulet Matos E. Diagnóstico por ecografía de cardiopatías complejas fetales. Experiencia de tres casos. Obstet Ginecol 1995;4:97-101.

  17. Allant LD, Tyman MJ, Campbel S, Wilkinson JW, Anderson RH. Echocardiography and anatomical correlates in the fetus. Br Heart J 1980;44:444-51.

  18. Arista Salado O, Fernández Fernández I, Javech García C. Diagnóstico prenatal de cardiopatías congénitas. Rev Cubana Pediatr 1988; 60(4):494-504.

  19. Allant LD. Examining the fetal heart. Br Heart J 1986;93:305-6.

  20. Arista Salado O, Fernández Fernández I, Javech García C. Diagnóstico ecocardiográfico en Cuba. Rev Cubana Obstet Ginecol 1991;17(1):17-26.

  21. Pérez Ramírez M, Fernández Fernández I, Mulet Matos E. Lipomatosis cardíaca. Diagnóstico intraútero por ecografía. Presentación de dos casos. Obstet Ginecol 1995;4:87-92.

  22. Pérez Ramírez M, Pérez Ramírez R, Mulet Matos E, Hartmann Guilarte A. Diagnóstico prenatal ecográfico de cardiopatías congénitas. Nuestra experiencia en el período 1993-1995. Obstet Ginecol 1996;5:15-9.

  23. Fernández Fernández I, Paruas Toll R, Pérez Ramírez M. Cardiopatía congénita. Informe de un caso diagnosticado intraútero por ultrasonido. Rev Esp Obstet Ginecol 1988;47:277-82.

  24. Savio Benavides A, Oliva Rodríguez J. Ecocardiografía fetal. Evaluación y resultados de un programa nacional. Cuba 1989-1991. Rev Cubana Pediatr 1995;67(1):13-20.

  25. Arista Salado O, Fernández Fernández I, Luis Pérez J. Diagnóstico prenatal del corazón univentricular. Rev Cubana Cardiol Cir Cardiovasc 1991;5(2):114.

  26. Allant LD, Crawford DC, Anderson RH, Tyman MJ. Echocardiographic and anatomical correlates in fetal congenital heart disease. Br Heart J 1984;52:542.

  27. Bonilla-Musolas FM. Diagnóstico prenatal de las malformaciones fetales. La Habana: Científico-Técnica, 1983:57-100.

  28. Allan LD., Hornberger LK. Textbook of Fetal cardiology. Londres. Greenwich Medical Media Limited. 2000.

  29. Wheller JJ, ReissR, Allen HD. Clinical experience with fetal echocardiography. Am J Dis Child 1990;144:49-53.

  30. Gembruch U. Prenatal diagnosis of congenital heart disease. Prenat Diagn 1997;17:1283-97.

  31. Rosendhal H, Kivinen S. Antenatal detection of congenital malformation by routine ultrasonography. Obstet Gynecol 1989;73:947-51.

  32. Lys F, Dewals P, Borlee Gremee I, Billeet A, et al. Evaluation of routine ultrasound examination for the prenatal diagnosis of malformation. Eur J Obstet Gynecol Reprod Biol 1989;30:101-9.

  33. Snijders RJM, Nicolaides KH. Assessment of risks in: ultrasound markers for fetal chromosome defects. Canforth, UK: Parthenon Publishing 1996;pp:63-120.

  34. Benacerraf BR. Should sonographic screening for fetal Down syndrome be applied to low risk women? Ultrasound Obstet Gynecol 2000;15:451-5.

  35. Stewad PA., Waldimiroff JW. Fetal atrial arrhythmias associated with redundancy / aneurysm of the foramen oval. J Clin Ultrasound 1988;16:643-50.

  36. Rice MJ, McDonald RW, Reller MD. Fetal atrial septal aneurysm: a case for fetal arrhythmias. J Am Coll Cardiol 1988;12:1292-7.

  37. Kleinman CS. Prenatal diagnosis and management of intrauterine arrhythmias. Fetal Ther 1896;1:92-5.

  38. Baxi L, bierman F, Ursell P. Evolution of complete heart block in a fetus and its perinatal management. Am J Perinatol 1987;4:348-51.

  39. Fesslova V, Nava S, Villa L, Fetal Cardiology Study Group of the Italian Society of Pediatric Cardiology. Evolution and long term outcome in cases with fetal diagnosis of congenital heart disease: Italian multicentre study. Heart 1999;82;594-9.

  40. Royal College of Obstetricians and Gynaecologists, Royal College of Paediatrics and Child Health. Background evidence supporting the guidelines. In: fetal abnormalities. Guidelines for screenings, diagnosis and management. London, UK: RCPCH, RCOG, 1997;p:5.

  41. Luck CA. Value of routine ultrasound scanning at 19 weeks: a four-year study of 8849 deliveries. Br Med J 1992;304:1474-8.

  42. Romero R. Routine obstetric ultrasound. Ultrasound Obstet Gynecol 1993;3:303-7.

  43. Crane JP, Le Fevre ML, Winborn RC, Evans JK, et al. A randomised trial of prenatal ultrasonographic screening: Impact on the detection, management, and outcome of anomalous fetuses. Am J Obstet Gynecol 1994;171:392-9.

  44. Grandjean H, Larroque D, Levi S, Eurofetus. The performance of routine ultrasonographic screening of pregnancies in the eurofetus study. Am J Obstet Gynecol 1999:181;446-54.

  45. Chitty LS, Pandya PP. Ultrasound screening for fetal abnormalities in the first trimester. Prenat Diagn 1997;17:1269-81.




2020     |     www.medigraphic.com