Prenatal diagnosis of congenital heart diseases: about 14 cases

Introduction:

Congenital heart disease, with a prevalence of 8/1000 live births, are one of the most frequent causes of perinatal mortality. They are responsible for half of malformations perinatal mortality. Their prenatal screening is more and more accessible thanks to the development of imaging techniques, especially ultrasound.

Objective:

The objective of this study is to identify what elements of ultrasound prenatal diagnosis that will help to reduce their impact and improve their management in postnatal care.

Patients and Methods:

This is a retrospective study of 14 cases of congenital heart disease collected in "A" Department of Obstetrics and Gynecology in CMNT between 2013 and 2015. All patients underwent early ultrasonography screening that showed heart malformations.

Results:

The average age of patients was 32 years. Prenatal diagnosis was carried out in all patients in "A" Department of Obstetrics and Gynecology in CMNT or in the Department of Pediatric Cardiology.

The average age at diagnosis was 22 SA.

Fetal autopsy was performed in 11 cases confirmed the diagnosis in all cases (100%).

In 09 cases there were multiple malformations.

Malformations	Number
Tetralogy of Fallot	2
Interventricular communication	2
Arterioventricular communication	4
Single ventricle	1
Septal hypertrophy	5

73% of these malformations were detected in prenatal ultrasound, confirmed by fetal autopsy.

Discussion:

Spontaneous intrauterine mortality in fetuses diagnosed with heart disease is approximately 10% (mostly related to chromosomal abnormalities or other malformations).

For fetuses with potentially lethal heart defects such as single ventricle or hypoplastic left heart syndrome: a medical termination can be suggested.

The most important group is represented by the cases requiring immediate postnatal care and surgical correction such as transposition of the great arteries, pulmonary atresia, hypoplastic left heart syndrome or hypoplasia of the aortic arch. In these cases the delivery must take place in a tertiary center with neonatal intensive care, pediatric cardiology and appropriate infrastructure for postnatal surgery.

In all these cases, the prenatal ultrasound diagnosis plays the most important role for the decision making process.

Conclusion:

Early diagnosis of congenital heart disease is fundamental. Identification of abnormalities should begin with the first trimester ultrasound, with detailed anomaly scan in the second trimester. Fetal heart ultrasound should be performed if the risk factors that increase the likelihood of heart defect are highlighted. Three-dimensional Ultrasound, ideally coupled to Doppler, can diagnose almost all heart defects.