engleski

Fetal echocardiography - our first experiences

During last year we have examed 38 pregnant women in our pediatric cardiology ambulance, in whom clinical course of pregnancy (nonimmune hydrops, suspected abnormality by screening sonogram, maternal diabetes or fetal arrhythmia) was pathological. Exam was performed on Vingmed 750 CFM ultrasonographic device with standard sector transducers of 3.25, 5 and 7.5 MHz. In evaluation we used transabdominal approach with following techniques and views: 2-D (four chambers view, five chambers view, view of ventricular outflow tracts, cross-sectional views), M-mode (measurment of chamber size, wall thickness and wall motion, cardiac rhythm assessment), pulsed Doppler and color flow Doppler (defining of blood flow). Gestational age at the time of exams was between 28 and 34 weeks (mean value 31 weeks). Pathological findings were verified on 8 (21%) fetal echocardiograms as follows: Patient 1. Dg: Dextrocardia. Single ventricle – undetermined type. Common atrioventricular valve. Atrial septal defect – ostium primum type. Subpulmonary stenosis with high gradient with dysplastic pulmonary valve (total gradient 60 mmHg). Normal position of great arteries. Hypoplastic pulmonary arteries. Child was born with severe central cyanosis and diagnosis was fully confirmed by echocardiography. Palliative procedure (modified Blalock-Taussig shunt) was performed. Child is now 11 months old in excellent general condition and prepared for next step operation towards total cavopulmonary connection. Patient 2. Dg: Hypoplastic left heart syndrome (mitral and aortal valve atresia). Diagnosis was confirmed immediately after birth and infusion of prostaglandine was started. Unfortunately, child died in age of two weeks, because adequate surgical treatment was not possible. Patient 3. Dg: Aneurismatically dilatated right ventricular with thicken walls. Dysplastic pulmonary valve with aneurismatic dilatation of pulmonary trunk. Prenatal dg: suspected fetopathy and cardiomyopathy. Child had died at age of 3 weeks in right heart decompesation. Patient 4. Dg: Large tumor inside left atrium with destruction of mitral valve. Mother delivered stillborn in 34th gestational week. Autopsy has not been performed due to techinical reasons. Patient 5. Dg: Persistent truncus arteriosus type I with dysplastic valve (stenosis and insufficiency). Postnatal evaluation (heart catheterisation and echocardiography) confirmed diagnose. Patient 6. Dg: Pulmonary atresia. Postnatal evaluation revealed severe stenosis of pulmonary valve and Down syndrome. Patients 7 and 8. Two fetuses had ventricular tachydisrhytmias and we had given amiodarone to mothers. On control exam 3 and 4 weeks later we have not found any arrythmic heart action.

fetal echocardiography; pregnancy

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