Value of multi-section ultrasound in prenatal diagnosis of congenital heart disease

Abstract

Objective To assess the value of multi-section ultrasound in prenatal diagnosis of congenital heart disease.Methods Totally,11 153 pregnant women,who underwent fetal echocardiography from January 17,2008 to March 15,2013 in People's Hospital of Xinjiang Uygur Autonomous Region,were retrospectively reviewed.The ultrasound scan was performed at (26.6± 5.8) weeks of gestation.Yagel Fivesection ultrasound (transverse view of the fetal upper abdomen,four-chamber view,left ventricular outflowtract view,right ventricular outflow-tract view and three-vessel view) was adopted as routine screening.If abnormal cardial structure was found,more sections would be associated,such as longitudinal view of the aortic arch,arterial arch axis section,upper and lower long axis view,great artery short axis view and heart outflow tract views.Autopsy results,neonatal surgical results or long term follow-up echocardiography results were compared with antenatal screening results to calculate the sensitivity,specificity,positive predictive value and negative predictive value of ultrasound screeing in prenatal diagnosis of congenital heart disease.Results Totally 10 071 cases with followed-up results were enrolled and analyzed.The detection rate of fetal congenital heart disease by prenatal ultrasound screening was 1.04％ (105/10 071).Among these detected 105 cases,there were three cases confirmed to be normal after birth and nine cases finally confirmed to be other cardiac anomalies,including three cases of double outlet of right ventricle with transposition of the great arteries detected prenatally but diagnosed as transposition of the great arteries postnatally; one case of persistent truncus arteriosus detected prenatally but diagnosed as tetralogy of Fallot complicated with pulmonary artery stenosis postnatally; one case of transposition of the great arteries detected prenatally but diagnosed as double outlet of right ventricle with transposition of the great arteries postnatally; one case of persistent truncus arteriosus detected prenatally but diagnosed as tetralogy of Fallot;one case of coarctation of the aorta detected prenatally but diagnosed as interruption of aorta postnatally; one case of hypoplastic left heart detected prenatally but diagnosed as single ventricle postnatally; one case of tetralogy of Fallot detected prenatally but diagnosed as double outlet of right ventricle postnatally.Among the 9 966 normal cases during prenatal ultrasound screening,there were 13 neonates with congenital heart diseases diagnosed after birth,including six cases ofventricular septal defect,three cases of coarctation of the aorta,two cases of ostiumsecundum defect and two cases of partial anomalous pulmonary venous drainage.The accuracy rate of prenatal ultrasound screening on congenital heart disease was 88.6％ (93/105).The sensitivity was 88.7％ (102/115) and specificity was 99.9％ (9 953/9 956),positive predictive value and negative predictive value were 97.1％ (102/105) and 99.9％ (9 953/9 966),respectively.Conclusion Multisection echocardiography could improve the accuracy of prenatal diagnosis of congenital heart disease. Key words: Heart defects, congenital; Ultrasonography, prenatal