Spectrum of antenatally diagnosed cardiac anomalies in a tertiary referral center of North India

Abstract

Background: Congenital heart disease (CHD) is the most frequent fetal anomaly seen during pregnancy. Prenatal diagnosis of CHD helps in ascertaining the prognosis of fetus and planning management. Early diagnosis and prompt intervention after delivery helps to prevent serious morbidity and mortality. Objective: To evaluate the type and pattern of fetal congenital cardiac anomalies to plan appropriate intervention. Methods: This was a retrospective study of all fetal cardiac anomalies detected on antenatal ultrasound in pregnant women at a tertiary care hospital for high-risk pregnancy in northern India. A detailed clinical evaluation and ultrasound of the fetus to look for all malformations including detailed cardiac evaluation was done in all pregnant patients. All women were thoroughly counseled regarding the malformations, possible causes, prognosis, and need for fetal karyotyping. Results: A total of 782 fetal malformations were observed during the study period, of which 211/782 (26.9%) fetuses were found to have cardiac malformation. 165/211 (78.2%) were isolated CHD and 46/211 (21.8%) had associated anomalies. The most common defect was ventricular septal defect (37/211, 17.5%) followed by fetal arrhythmias (29/211, 13.7%), hypoplastic left heart syndrome (27/211, 12.8%), tetralogy of Fallot (21/211, 9.9%), atrioventricular septal defect (18/211, 8.5%), and double outlet right ventricle (14/211, 6.6%). 96/211 (45.5%) couples opted for prenatal invasive testing, of which 14/96 (14.5%) fetuses were found to have abnormal genetic studies, most common being down syndrome. Conclusion: The problem of CHD is of profound importance, and suspected cardiac anomaly is the main reason for referral. After identification of CHD, couple should be offered genetic studies and detailed counseling, and timely cardiac intervention should be planned when indicated.