Antenatal diagnosis of cardiac malformation: a structural study

The purpose of this study was to find out the functional and anatomical relationship between the various cardiac segments in congenital heart disease before and after birth. This study of cardiac pathology focused on 227 fetuses referred to fetal echocardiography because of suspicion of congenital heart defects (CHD) from 1986 to 1991. The heart was imaged and classified according to a division into 7 adjacent segments. Normality or abnormality of each segment and of the general state of the subject's heart was coded in a binary mode, in which 0 = normal and 1 = pathological. We also coded the extracardiac morphology, noting existence or absence of another extracardiac defect in the fetus. The binary segmental data were entered into a worksheet for further analysis. Observations were conducted prenatally and verified after birth or abortion. Fetal echocardiography was first assessed using conventional statistical analysis. The calculated accuracy and predictive values to diagnose any cardiac defect as well as for correctly coding abnormal or normal cardiac segments were excellent. Then, using HUDAP software (Hebrew University Data Analysis Package), we could demonstrate a perfect fit between the functional and pathological structure of the cardiac segments in the fetus. Moreover, using this unique type of data analysis, we found a multidimensional scaling confirmation of the embryogenesis theory of the heart.