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Echocardiographic evaluation of dilated cardiomyopathy in the human fetus
K G Schmidt1, E Birk, N H Silverman
1Division of Pediatric Cardiology, University of California, San Francisco 94143.
Insights
Dilated cardiomyopathy can develop before birth. Serial echocardiography may diagnose fetal dilated cardiomyopathy, but prenatal diagnosis indicates a poor prognosis for affected newborns.
Area of Science:
- Cardiology
- Fetal Medicine
- Pediatric Cardiology
Background:
- Dilated cardiomyopathy is a serious cardiac condition.
- Prenatal diagnosis of cardiac conditions is crucial for early intervention.
Purpose of the Study:
- To investigate the occurrence and diagnosis of dilated cardiomyopathy in fetuses.
- To assess the prognostic implications of prenatal dilated cardiomyopathy.
Main Methods:
- Echocardiography was used to study 625 fetuses.
- Serial echocardiographic examinations were performed in select cases.
- Fetal cardiac function and dimensions were assessed.
Main Results:
- Dilated cardiomyopathy was diagnosed in 6 of 625 fetuses.
- Abnormal findings included reduced fractional shortening, valve regurgitation, abnormal chamber dimensions, and nonimmune hydrops.
- A normal mid-trimester echocardiogram did not exclude later development of the condition.
- Only 2 neonates survived, with 1 requiring a heart transplant.
Conclusions:
- Dilated cardiomyopathy can manifest during fetal development.
- Serial fetal echocardiography can aid in diagnosis.
- Prenatal diagnosis of dilated cardiomyopathy is associated with a poor prognosis.
Abstract:
The diagnosis of dilated cardiomyopathy was established and subsequently confirmed in 6 of 625 fetuses studied by echocardiography. All 6 had structurally normal hearts. Abnormal findings included reduced fractional shortening index in 5, atrioventricular valve regurgitation in 3, abnormal chamber dimensions in 3 and nonimmune hydrops in 4. In 2 fetuses referred because of a family history of dilated cardiomyopathy in previous siblings, echocardiographic abnormalities were absent on a first examination performed at 20 weeks of gestation. This suggested that a normal fetal echocardiogram in a midtrimester fetus does not always rule out the subsequent development of dilated cardiomyopathy. However, all fetuses followed serially developed some abnormality later in pregnancy. Only 2 neonates survived, 1 of whom required a heart transplant during infancy. Death from cardiac failure occurred in 1 fetus and 3 neonates. This study demonstrates that dilated cardiomyopathy may develop during fetal life and might be diagnosed by echocardiography if serial studies are performed. Dilated cardiomyopathy presenting prenatally appears to have a poor prognosis.