Fetal anatomic and functional echocardiography: a 5-year review

To assess the concordance of fetal and postnatal echocardiography when congenital heart disease is suspected prenatally.

The perinatology and pediatric cardiology ultrasound databases were searched for fetal echocardiograms obtained between June 1995 and June 2000. All cases with abnormal fetal echocardiographic findings in which postnatal echocardiography was performed were included. A perinatologist, pediatric cardiologist, or both interpreted all fetal echocardiograms; a pediatric cardiologist interpreted all postnatal echocardiograms. The fetal and postnatal echocardiograms were compared for the presence of 25 specific components. The kappa statistic was calculated to evaluate concordance between fetal and postnatal studies. Positive and negative predictive values for fetal studies were calculated under the assumption that the postnatal study yielded the correct diagnosis.

Sixty-five patients were included. Congenital heart disease ranged from an isolated atrial septal defect to complex disease. Images adequately showed all 25 components in more than 85% of the fetal studies. Concordance between fetal and postnatal echocardiograms was excellent (kappa > 0.75) for 20 of the 25 components evaluated. Four of the remaining 5 components had fair concordance (kappa = 0.4-0.75) between fetal and postnatal studies. Structural abnormalities without excellent concordance included partial anomalous pulmonary venous return, secundum atrial septal defects, and heart malposition. Concordance between fetal and postnatal right and left ventricular function was fair; however, differences may have been due to physiologic changes that occurred after birth rather than to inferior diagnostic accuracy of fetal echocardiography.

Fetal echocardiography is an extremely useful and accurate clinical tool for prenatal and postnatal evaluation of congenital heart disease.