Prenatal diagnosis of congenital heart diseases: Retrospective evaluation of fetal echocardiography performed between 2010-2019

Aim: We aimed to define the risk factors of pregnant women referred to our center for antenatal diagnosis of congenital heart diseases, and to retrospectively examine the results of prenatal and postnatal echocardiography, and to evaluate the frequency and distribution of fetal cardiac anomalies in low and high risk pregnancies for congenital heart disease, and the sensitivity and specificity of the fetal echocardiography method. Patients and methods: In this study, fetal echocardiographic examination performed between January 2010 and December 2019 in Karadeniz Technical University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Cardiology was evaluated retrospectively. Pregnant women were divided into two groups as high / medium risk (group 1) and low risk (group 2) for fetal heart anomalies according to their application indications. Sensitivity and specificity analysis was performed by comparing antenatal and postnatal data. Results: In our study, echocardiography was performed on 4077 fetuses between 2010 and 2019. The information of 3677 (90.4%) of 4067 fetuses who underwent fetal echocardiography was obtained through hospital records and telephone interviews. During the first fetal echocardiography, the gestational age of the fetuses was between 15-39 weeks (23 ± 4.5). The most used year of fetal echocardiography was 2019 (n: 789, 19.4%), and the year with the most abnormal cardiac findings was 2017 (n: 158 18.4%). Congenital heart disease was found in 10.3% (n: 419) of the fetuses who underwent fetal echocardiography. The most common cardiac anomalies detected in fetuses were ventricular septal defect (n:67, 16%), hypoplastic left heart syndrome (n:57, 13,6%) and complete atrioventricular septal defect (n: 38, 8.9%). Congenital heart disease was detected in 386 (12.6%) of 3074 fetuses in Group 1 and 33 (5.5%) of 603 fetuses in group 2. The genders of 419 fetuses that were found to have congenital heart disease in fetal echocardiography were 204 (48.7%) female and 215 (51.3%) male. The most common reasons for applying to our clinic are; suspicion of cardiac anomaly (n: 1431, 36.4%), diabetes mellitus in pregnant women (n: 369, 9.4%), and abnormal findings in non-cardiac organs and systems in obstetric ultrasonography (n: 342, 8.7%). The concordance of prenatal and postnatal results was 97.2%. In our study, fetal echocardiography sensitivity was 94.9% and specificity was 97.6%. Conclusion: In our study, we found a high rate of congenital heart disease in fetuses of high-risk pregnancies. However, due to the fact that congenital heart disease has been detected in low-risk pregnant women, fetal echocardiography should be performed in all pregnant women if the staff and equipment of the pediatric cardiology clinic are appropriate. Performing fetal echocardiography especially in the early period and diagnosing congenital heart disease in the fetus; It is effective in the psychological preparation of the family before the birth, the decision of the family to continue the pregnancy, antenatal follow-up of the fetus and planning the birth at or near a cardiac surgery center when cardiac surgery is required.