Frequency Of The Congenital Heart Diseases According To The Risk Groups: Fetal Echocardiographic Screening

Öz

Aim: The aim of this study is to evaluate fetal echocardiography results in terms of congenital heart diseases CHD in high and low risk pregnancies in our clinic.Material and Methods: Echocardiographic records of 1025 pregnant women referred to the pediatric cardiology unit between September 2006- December 2015 were retrospectively evaluated.Results: Congenital heart disease was detected in 134 13.1% of all fetuses in high and low risk groups. Ventricular septal defect 38.8% and atrioventricular septal defect 11.9% were the most common two pathologies. The third one was multiple complex anomalies 11.2% . The prevalence of CHD in the high-risk group n=390 was 13.3% and 16.3%in the low-risk group n=635 . There was no difference between risk groups in incidence of CHD p>0.05 . Minor cardiac pathologies were detected in 5.9%, complex pathologies were 5.1% and significant cardiac pathologies were 2.3% of the high risk pregnancies. Minor cardiac pathologies were detected in 7.4%, complex pathologies were 6.1%, and significant cardiac pathologies were 2.8% of the low-risk group pregnancies. The rate of CHD detection in the group that referred for suspicion of cardiac anomaly was 27.7% whereas, the rate of CHD detection in the group that referred for other reasons was 13.7% p=0.01 .Conclusion: Fetal echocardiography is a reliable method for diagnosis of intrauterine heart diseases. In this study, it was determined that CHD was high in the group that was referred for cardiac anomaly; nevertheless the risk classification was not satisfactory in distinguishing presence of CHD in groups.

Anahtar Kelimeler

• Congenital heart disease,fetal echocardiography,fetus,prenatal diagnosis

Doğumsal Kalp Hastalıkları Sıklığının Risk Gruplarına Göre Dağılımı: Fetal Ekokardiyografik Tarama

Öz

Giriş: Bu çalışmanın amacı, kliniğimizde yüksek ve düşük risk grubundaki gebelerde fetal ekokardiyografi sonuçlarını doğumsal kalp hastalıkları DKH açısından değerlendirmektir.Gereç ve Yöntemler: Pediatrik Kardiyoloji Ünitesine Eylül 2006-Aralık 2015 tarihleri arasında başvuran 1025 gebenin ekokardiyografi kayıtları retrospektif olarak incelendi.Bulgular: Yüksek ve düşük riskli gruplardaki tüm fetüslerin 134’ünde %13.1 doğumsal kalp hastalığı saptandı. Ventriküler septal defekt %38.8 ve atriyoventriküler septal defekt %11.9 en sık görülen patolojilerdi. Birden fazla kompleks anomaliyi içeren patolojilerin oranı ise üçüncü sırada yer almaktaydı %11.2 . Yüksek riskli grupta n=390 DKH sıklığı %13.3 iken düşük riskli grupta n=635 %16.3 bulundu. Doğumsal kalp hastalığı sıklığı açısından risk grupları arasında anlamlı fark yoktu p>0.05 . Yüksek riskli grubun %5.1’inde kompleks, %2.3’inde önemli ve %5.9’unda ise minör kardiyak patoloji saptandı. Düşük riskli grupta ise %6.1 kompleks, %2.8’inde önemli ve %7.4’ünde minör kardiyak patoloji saptandı. Annede başvuru nedenleri irdelendiğinde; kardiyak anomali şüphesi ile yönlendirilen grupta DKH saptanma oranı %27.7 iken, diğer nedenlerle başvuranlarda bu oran %13.7 idi p=0.01 .Sonuç: Fetal ekokardiyografi intrauterin kalp hastalıkların tanınmasında güvenilir bir yöntemdir. Bu çalışmada, anomali şüphesi ile yönlendirilen grupta DKH oranının yüksek olduğu saptanmakla birlikte, risk gruplarının DKH’nı öngörmede ayırt edici olmadığı belirlenmiştir. Bu da fetal ekokardiyografinin rutin bir inceleme olması gerektiğini düşündürmektedir.

Anahtar Kelimeler

• Doğumsal kalp hastalığı,fetal ekokardiyografi,fetüs,prenatal tanı

Kaynakça

1. Verheijen PM, Lisowski LA, Stoutenbeek P, Hitchcock JF, Brenner JI, Co- pel JA, et al. Prenatal diagnosis of congenital heart disease affects pre- operative acidosis in the newborn patient. J Thorac Cardiovasc Surg 2001;121(4):798–803.
2. 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 Obstet Gynecol 2001;17(5):380–5.
3. Young ID, Clarke M. Lethal malformations and perinatal mortality: a ten year review with comparison of ethnic differences. Br Med J. 1987; 295: 89- 91.
4. Nora JJ, Berg K, Nora AH (Eds). Cardiovascular Diseases: Genetics, Epidemiology and Prevention. Oxford Monographs on Medical Genetics, no.22. Oxford University Press: Oxford, 1991.
5. Hoffman JI. Incidence of congenital heart disease. I: Postnatal incidence. Pediatr Cardiol 1995; 16: 103-13.
6. Allan L, Dangel J, Fesslova V, Marek J, Mellander M, Oberhansli I, et al. Recommendations for the practice of fetal cardiology in Europe. Cardiol Young 2004; 14: 109-14.
7. Perri T, Cohen-Sacher B, Hod M, Berant M, Meizner I, Bar J. Risk factors for cardiac malformations detected by fetal echocardiography in tertiary center. J Matern Fetal Neonatal Med 2005; 17: 123-8.
8. Todros T, Faggiano F, Chiappa E, Gaglioti P, Mitola B, Sciarrone A. Ac- curacy of routine ultrasonography in screening heart disease prenatally. Prenat Diagn 1997; 17: 901-6.

9. Hunter S, Heads A, Wyllie J, Robson S. Prenatal diagnosis of congenital heart disease in the northern region of England: benefits of a training program for obstetric ultrasonographers. Heart 2000; 84: 294-8.
10. Wren C, Richmond S, Donaldson L. Temporal variability in birth prevalen- ce of cardiovascular malformations. Heart 2000; 83: 414-9.
11. Tegnander E, Williams W, Johansens OJ, Blaas HG, Eik-Nes SH. Prenatal detection of heart defects in a non-selected population of 30149 fetuses - detection rates and outcome. Ultrasound Obstet Gynecol 2006; 27: 252-65.
12. Ozbarlas N, Erdem S, Kucukosmanoglu O, Seydaoglu G, Demir C, Evruke C, et all. Prevalence and distribution of structural heart diseases in high and low risk pregnancies. Anadolu Kardiyol Derg 2011;2: 125-30.
13. Ozkutlu S, Ayabakan C, Karagoz T, Onderoğlu L, Deren O, Cağlar M, et al. Prenatal echocardiographic diagnosis of congenital heart disease: com- parison of past and current results. Turk J Pediatr 2005; 47: 232-8.
14. Cooper MJ, Enderlein MA, Dyson DC, Roge CL, Tarnoff H. Fetal echocar- diography: retrospective review of clinical experience and an evaluation of indications. Obstet Gynecol 1995; 86: 577-82.
15. Simpson LL. Indications for fetal echocardiography from a tertiarycare obstetric sonography practice. J Clin Ultrasound 2004; 32: 123-8.
16. Paladini D, Russo MG, Teodoro A, Pacileo G, Capozzi G, Martinelli P, et al. Prenatal diagnosis of congenital heart disease in the Naples area during the years 1994-1999 - the experience of a joint fetalpediatric cardiology unit. Prenat Diagn 2002; 22: 545-52.