The role of fetal echocardiogram after detection of extracardiac anomalies in utero (fetal echocardiogram for extracardiac malformations). (22nd July 2021)

• Record Type: Journal Article
• Authors: Barris, David M.; Brailovschi, Yaniv; Shah, Amee; Levasseur, Stéphanie; Nhan‐Chang, Chia‐Ling; Miller, Russell; Simpson, Lynn; Freud, Lindsay R.
• Is Part Of: Prenatal diagnosis. Volume 41:Number 9(2021)
• Page Start: 1134
• Page End: 1139
• Publication Date: 2021-07-22
• Subjects: Prenatal diagnosis -- Periodicals; Fetus -- Diseases -- Diagnosis -- Periodicals; Electronic journals; 618.32075
• DOI: 10.1002/pd.6012
• Languages: English
• ISSNs: 0197-3851

Abstract

Abstract: Objective: We aimed to investigate the utility of comprehensive screening fetal echocardiography (FE) for patients diagnosed with any type of fetal extracardiac malformation (ECM) at a single multidisciplinary fetal center. Methods: We retrospectively reviewed all patients presenting to our referral center for FE due to a prenatal diagnosis of ECM (January 2013–December 2018). Results: Among 641 patients with ≥1 ECM referred for FE, 78 (12.2%) had CHD diagnosed at 25.6 ± 0.5 weeks. The frequency of CHD by type of ECM ranged from 35.1% for craniofacial to 9.8% for thoracic. Increasing number of fetal ECMs was strongly associated with CHD: odds ratio 2.01 (95% confidence interval: 1.06–3.69) for two ECMs, 9.57 (2.00–49.05) for three ECMs, and 11.68 (3.84–37.15) for more than three ECMs. Of fetuses with ECM and an abnormal genetic finding, 33.3% had CHD as compared to 10.9% of those without ( p < 0.0001). Obstetric anatomy sonogram detected 43.6% of CHD. Conclusion: CHD was commonly diagnosed among fetuses with any type of ECM at our center but was not always detected on obstetric sonogram. As the presence of CHD may impact decision‐making and perinatal care, patients with a diagnosis of any fetal ECM should be considered for FE. Key points: What's already known about this topic? The presence of congenital heart disease by type of extracardiac malformation (ECM) has predominantly been described in the neonatal literature. Little is known in the prenatal setting regarding the presence of congenital heart disease following the diagnosis of a fetal malformation. We aimed to investigate the utility of a comprehensive fetal echocardiogram for patients diagnosed with any type of fetal ECM at our multidisciplinary fetal center. What does this study add? We found a high yield of fetal echocardiogram following the diagnosis of any type of fetal ECM at our center, even when the cardiac views on obstetric sonogram were normal. For fetuses with multiple ECMs and/or an abnormal genetic finding, congenital heart disease was particularly common. Therefore, patients with a diagnosis of any type of fetal ECM should be considered for fetal echocardiogram.