ANTEPARTUM DIAGNOSIS OF CONGENITAL ANOMALY OF THE HEART

Abstract

THE recognition of congenital anomalies of the heart of the fetus has received scant mention in medical literature. Because such a condition was observed and correctly diagnosed antepartum, this report of the case should be of interest. Hyman states that the condition may not be noted because enough time is not devoted to adequate fetal cardiac auscultation. Other aspects of the routine examination are regarded as more important and to detect the presence or absence of the sounds of the fetal heart usually suffices. The incidence of congenital heart disease declines with advancing age, especially the more severe lesions which are incompatible with life beyond the first weeks or months following birth. Clinical evidence of congenital heart disease has been noted in 0.3% of newborn infants and in from 0.05% to 0.15% of school age children. Maude Abbott, in 3,633 autopsies of all age groups, recorded 43 cases (1.2%) with congenital anomalies of the heart. Perusal of medical literature of the past hundred years shows that Massman, in 1854, was the first to record the recognition of an unusual fetal cardiac murmur; he suspected a congenital anomaly of the heart, and this diagnosis was confirmed at autopsy. Barth, in 1880, likewise described a case which was confirmed at autopsy. Padgett, in 1894, the first American to record such a diagnosis, believed that he heard the murmur of mitral valvular disease in a fetus and his suspicion was substantiated at autopsy. Others reporting similar cases included Bellot and Andry and Lacroix. Hoehne, from a study of his own case and seven others collected from the literature, proposed three criteria for the diagnosis of fetal congenital cardiac lesions: 1. There is a murmur rough in character, of constant duration and intensity, but not synchronous with the maternal pulse. 2. For the most part, there is a constant defect in both heart sounds; usually the first and occasionally only the first sound is heard. 3. The murmur is heard over the entire abdomen of the mother with greatest intensity in the area where the fetal cardiac sounds are heard best. During studies of routine fetal phonocardiograms in 31 cases, Sampson and others reported one case of fetal congenital anomaly of the heart. Dipple made a comprehensive review of the literature and added two cases of his own, each having an interventricular septal defect, a patent foramen ovale and a patent ductus arteriosus.