Current follow-up results of Cyanotic Congenital Heart Diseases detected during Pregnancy in a specific Region

Yıl 2024, Cilt: 14 Sayı: 2, 72 - 76, 28.03.2024

Derya Duman , Derya Karpuz

https://doi.org/10.16899/jcm.1444862

Öz

Background/Aims: Congenital heart disease (CHD) is the main cause of death in infants among congenital anomalies. Fetal echocardiography is important for the diagnosis and treatment plan of congenital heart diseases in the prenatal period. This study aimed to retrospectively screen the follow-up and treatment results of cyanotic CHD patients detected on fetal echocardiography.
Methods: Fetal echocardiography results were scanned from the hospital record system. Data of fetuses with major cardiac anomalies and cyanotic CHD were examined retrospectively.
Results: Fetal echocardiography was performed on 420 pregnant women between July 2020 and April 2023. Major cardiac anomalies and cyanotic heart disease were detected in the fetuses of 40 pregnant women (9.5%) out of 420. The median age of the pregnant women was 29 (19-41 years). The median gestational age at check-up was 23 weeks (22-28 weeks). 9/40 pregnant women (22.5%) had risk factors.
The most common cyanotic congenital heart diseases were hypoplastic left heart syndrome (HLHS) and unbalanced complete atrioventricular septal defects (AVSDs) with obstructive lesions of the right or left ventricle. Three fetuses (7.5%) with heart failure findings died intrauterine. Two fetuses with HLHS and critical aortic stenosis (AS) died before being operated on. A patient with complete AVSD, hypoplasia of the left heart chambers, AS, and severe aortic coarctation died due to sepsis during the post-operative follow-up period. Chromosome analysis was performed in 8 patients. Down syndrome was detected in 3 of the patients with complete AVSD. 22q11 deletion and DiGeorge Syndrome were detected in 2 patients with tetralogy of Fallot.
Conclusions: Congenital heart diseases and rhythm problems can be safely detected with fetal echocardiography. It is beneficial to perform a fetal echo scan at the appropriate gestational week, especially in fetuses with risk factors and in whom the four chambers view cannot be seen.

Anahtar Kelimeler

fetal echocardiography, prenatal screening, cyanosis, congenital heart disease.

Gebelikte Belirli Bir Bölgede Tespit Edilen Siyanotik Konjenital Kalp Hastalıklarının Güncel Takip Sonuçları

Öz

Giriş-Amaç
Konjenital kalp hastalığı (KKH), konjenital anomalili bebeklerde önde gelen ölüm nedenidir. Fetal ekokardiyografi konjenital kalp hastalıklarının prenatal dönemdeki tanı ve tedavi planı açısından önemlidir. Bu çalışma ile fetal ekokardiyografide saptanan siyanotik KKH hastalarının takip ve sonuçlarının retrospektif olarak taranması amaçlandı.
Gereçler ve Yöntem
Fetal ekokardiyografi sonuçları ekokardiyografi kayıt sisteminden tarandı. Major kardiyak anomali ve siyanotik KKH olan fetusların verileri geriye dönük incelendi.
Bulgular
Temmuz 2020-Nisan 2023 tarihleri arasında 420 gebeye fetal ekokardiyografi yapıldı. 420 gebenin 40'ının (%9,5) fetusunda majör kalp anomalisi ve siyanotik kalp hastalığı tespit edildi. Gebelerin ortalama yaşı 29 (19-41 yıl) idi. Ortalama gebelik yaşı 23 hafta (22-28 hafta) idi. Gebe kadınların 9/40'ında (%22,5) risk faktörleri vardı.
En sık görülen siyanotik konjenital kalp hastalıkları hipoplastik sol kalp sendromu (HSKS) ve sağ veya sol ventrikülün obstrüktif lezyonlarıyla birlikte dengesiz tam atriyoventriküler septal defektlerdi (AVSD). Kalp yetmezliği bulguları olan 3 fetüs (%7,5) intrauterin dönemde kaybedildi. HLHS'li ve kritik aortik darlığı (AD) olan iki fetüs ameliyat edilmeden önce öldü. Komplet AVSD, sol kalp boşluklarında hipoplazi, AD ve ciddi aort koarktasyonu olan bir hasta, ameliyat sonrası takip sırasında sepsis nedeniyle kaybedildi. 8 hastaya kromozom analizi yapıldı. Komplet AVSD'li hastaların 3'ünde Down sendromu saptandı. Fallot tetralojili 2 hastada 22q11 delesyonu ve DiGeorge Sendromu tespit edildi.
Tartışma ve Sonuç
Fetal ekokardiyografi ile konjenital kalp hastalıkları ve ritm problemleri güvenli olarak tespit
edilebilmektedir. Özellikle risk faktörleri olan, dört boşluk net görülemeyen gebelerde uygun gebelik haftasında fetal eko taraması yapılmasında fayda vardır.

Anahtar Kelimeler

fetal ekokardiyografi, prenatal tarama, siyanoz, konjenital kalp hastalığı.

Kaynakça

• 1. van der Bom T, Zomer AC, Zwinderman AH, Meijboom FJ, Bouma BJ, Mulder BJ. The changing epidemiology of congenital heart disease. Nat Rev Cardiol. 2011;8(1):50-60.
• 2. Çaylan N, Yalçın SS, Tezel B, Üner O, Aydin Ş, Kara F. Evaluation of critical congenital heart disease from 2018 to 2020 in Turkey: a retrospective cohort study. BMC Pregnancy Childbirth. 2023;23(1):871.
• 3. Heron MP. Deaths: leading causes for 2017. 2019.
• 4. Weissmann-Brenner A, Mitlin A, Hoffman C, Achiron R, Salem Y, Katorza E. Assessment of the Association Between Congenital Heart Defects and Brain Injury in Fetuses through Magnetic Resonance Imaging. Isr Med Assoc J. 2020;22(1):27-31.
• 5. Reza Alipour M, Moradi H, Mahdieh Namayandeh S, Majidpoure F, Pezeshkpour Z, Sarebanhasanabadi M. Abnormal findings in fetal echocardiography and maternal disease: A cross-sectional study. Int J Reprod Biomed. 2022;20(5):405-12.
• 6. Karippaliyil B, Karippaliyil M, Karippaliyil L. Fetal cardiac sectional schemas - Normal and abnormal. Part 1: Upper abdominal and thoracic sections. Ann Pediatr Cardiol. 2022;15(4):380-8.
• 7. Miranović V. The incidence of congenital heart disease: previous findings and perspectives. Srp Arh Celok Lek. 2014;142(3-4):243-8.
• 8. Namuyonga J, Lubega S, Aliku T, Omagino J, Sable C, Lwabi P. Pattern of congenital heart disease among children presenting to the Uganda Heart Institute, Mulago Hospital: a 7-year review. Afr Health Sci. 2020;20(2):745-52.
• 9. Liu H, Zhou J, Feng QL, Gu HT, Wan G, Zhang HM, et al. Fetal echocardiography for congenital heart disease diagnosis: a meta-analysis, power analysis and missing data analysis. Eur J Prev Cardiol. 2015;22(12):1531-47.
• 10. Rakha S, El Marsafawy H. Sensitivity, specificity, and accuracy of fetal echocardiography for high-risk pregnancies in a tertiary center in Egypt. Arch Pediatr. 2019;26(6):337-41.
• 11. Achiron R, Glaser J, Gelernter I, Hegesh J, Yagel S. Extended fetal echocardiographic examination for detecting cardiac malformations in low risk pregnancies. Bmj. 1992;304(6828):671-4.
• 12. Gao S, Han J, Yu S, Guo Y, Ruan Y, Fu Y, et al. Comparison of fetal echocardiogram with fetal cardiac autopsy findings in fetuses with congenital heart disease. The Journal of Maternal-Fetal & Neonatal Medicine. 2021;34(23):3844-50.
• 13. Friedman KG, Tworetzky W. Fetal cardiac interventions: Where do we stand? Arch Cardiovasc Dis. 2020;113(2):121-8.
• 14. Schidlow DN, Freud L, Friedman K, Tworetzky W. Fetal interventions for structural heart disease. Echocardiography. 2017;34(12):1834-41.
• 15. Edwards LA, Arunamata A, Maskatia SA, Quirin A, Bhombal S, Maeda K, et al. Fetal Echocardiographic Parameters and Surgical Outcomes in Congenital Left-Sided Cardiac Lesions. Pediatr Cardiol. 2019;40(6):1304-13.
• 16. Bravo-Valenzuela NJ, Peixoto AB, Araujo Júnior E. Prenatal diagnosis of congenital heart disease: A review of current knowledge. Indian Heart J. 2018;70(1):150-64.
• 17. Ngwezi DP, McClean M, McBrien A, Eckersley L, Abeysekera J, Colen T, et al. Prenatal features of ductus arteriosus-related branch pulmonary stenosis in fetal pulmonary atresia. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2021;58(3):411-9.
• 18. Rauch R, Hofbeck M, Zweier C, Koch A, Zink S, Trautmann U, et al. Comprehensive genotype-phenotype analysis in 230 patients with tetralogy of Fallot. J Med Genet. 2010;47(5):321-31.