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Fetal dextrocardia: diagnosis and outcome in two tertiary centres
A Bernasconi1, A Azancot, J M Simpson
1Fetal Cardiology Unit, Hôpital Robert Debré, Paris, France.
Insights
Fetal dextrocardia occurs in 0.22% of fetuses and is often associated with congenital heart disease. Early detection via fetal echocardiography is crucial for parental counseling and managing outcomes.
Area of Science:
- Cardiology
- Prenatal Diagnosis
- Medical Imaging
Background:
- Dextrocardia, a condition where the heart's major axis points right, can be associated with significant cardiac and extracardiac malformations.
- Understanding the incidence and spectrum of anomalies in fetal dextrocardia is vital for prenatal management.
Purpose of the Study:
- To determine the incidence of fetal dextrocardia.
- To evaluate associated cardiac and extracardiac malformations.
- To assess pregnancy outcomes in fetuses with dextrocardia.
Main Methods:
- Retrospective echocardiographic study of 81 fetuses with dextrocardia.
- Inclusion of cases from two tertiary fetal cardiology centers.
- Analysis of cardiac and extracardiac malformations based on atrial situs (solitus, ambiguus, inversus).
Main Results:
- The incidence of fetal dextrocardia was 0.22%.
- Congenital heart disease was prevalent, particularly in cases with situs ambiguus (96%).
- Outcomes varied by situs, with higher rates of interrupted pregnancies and deaths in situs ambiguus.
Conclusions:
- Fetal dextrocardia is frequently associated with congenital heart disease, with varying incidence based on atrial situs.
- Fetal echocardiography is essential for detecting complex cardiac anomalies.
- Accurate diagnosis facilitates appropriate parental counseling and management planning.
Objective:
To evaluate the incidence of fetal dextrocardia, associated cardiac and extracardiac malformations, and outcome.
Design:
Retrospective echocardiographic study.
Setting:
Two tertiary centres for fetal cardiology.
Patients:
81 consecutive fetuses with a fetal dextrocardia presenting at Guy's Hospital, London, between 1983 and 2003 and at Hôpital Robert Debré, Paris, between 1988 and 2003. Fetal dextrocardia was defined as a condition in which the major axis of the heart points to the right.
Results:
The incidence was 0.22%. There were 38 fetuses (47%) with situs solitus (SS), 24 (30%) with situs ambiguus (SA), and 19 (23%) with situs inversus (SI). Structural cardiac malformations were found in 25 cases (66%) of SS, 23 cases (96%) of SA, and 12 cases (63%) of SI. Extracardiac malformations were identified in 12 cases (31%) of SS, in five cases (21%) of SA, and in two cases (10%) of SI. Of the 81 cases of fetal dextrocardia, there were 27 interrupted pregnancies (15 of 24 SA, 10 of 38 SS, and 2 of 19 SI), six intrauterine deaths (3 of 38 SS, 2 of 24 SA, and 1 of 19 SI), and five neonatal deaths (3 of 24 SA, 1 of 19 SI, and 1 of 38 SS). There were 43 survivors (24 of 38 SS, 15 of 19 SI, and 4 of 24 SA).
Conclusion:
The majority of fetuses with dextrocardia referred for fetal echocardiography have associated congenital heart disease. There is a broad spectrum of cardiac malformation and the incidence varies according to the atrial situs. Fetal echocardiography enables detection of complex congenital heart disease so that parents can be appropriately counselled.
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