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Fetal cardiomegaly: echocardiographic findings and outcome in 19 cases
R Chaoui1, R Bollmann, B Göldner
1Department of Prenatal Diagnosis and Therapy, Humboldt University, Berlin, FRG.
Insights
Fetal cardiomegaly, often detected around 31.5 weeks, frequently involves tricuspid regurgitation and right atrial enlargement. This condition, particularly with hydrops or lung hypoplasia, is associated with a high mortality rate in fetuses.
Area of Science:
- Fetal Cardiology
- Prenatal Diagnosis
- Pediatric Echocardiography
Background:
- Marked cardiomegaly in fetuses presents a significant diagnostic challenge.
- Abnormal cardiac findings are the primary reason for referral in most cases.
Purpose of the Study:
- To review echocardiographic findings and clinical outcomes in fetuses with marked cardiomegaly.
- To identify common pathogenetic features and prognostic indicators.
Main Methods:
- Retrospective review of 19 fetuses with marked cardiomegaly (defined by specific echocardiographic ratios).
- Intracardiac hemodynamics assessed using pulsed, color, and M-Mode color Doppler.
- Correlation of cardiac measurements with fetal outcome.
Main Results:
- A common feature was holosystolic tricuspid regurgitation with right atrial enlargement in 89.4% of cases.
- Hydrops was present in 52.6% of fetuses.
- A high mortality rate of 83.3% was observed; the heart/thoracic area (CTA) ratio correlated with outcome, and CTA ratio > 0.6 indicated lung hypoplasia.
Conclusions:
- Holosystolic tricuspid regurgitation and right atrial enlargement are common in fetal cardiomegaly.
- Hydrops, right ventricular outflow tract obstruction, and lung hypoplasia are poor prognostic signs.
- Accurate differentiation of pulmonary valve abnormalities is challenging with Doppler in severe tricuspid regurgitation.
Abstract:
The echocardiographic findings and clinical courses in 19 fetuses with marked cardiomegaly [heart length, width, area, cardiothoracic ratio, heart/thoracic area (CTA) ratio > 2 SD] were reviewed. An abnormal heart was the reason for referral in 16 cases of 19 (84.2%). The mean gestational age was 31.5 weeks at detection. Intracardiac hemodynamics were studied using pulsed, color, and M-Mode color Doppler. Despite the heterogeneous etiology of marked cardiomegaly (5 Ebstein's anomalies, 5 tricuspid valve dysplasias, 3 dilatative cardiomyopathies and 6 miscellaneous) a holosystolic tricuspid regurgitation with right atrial enlargement was found in 17 of the 19 cases (89.4%) as a common pathogenetic feature. A hydrops was found in 10 cases (52.6%). Besides 1 elective legal abortion, a high mortality rate of 83.3% was observed in the group followed up (6 intrauterine and 9 neonatal deaths). Among the cardiac measurements the CTA ratio seemed to correlate with fetal outcome, since all three survivors had the lowest values and all fetuses with CTA ratio > 0.6 showed a lung hypoplasia as a sequel of compression by cardiac enlargement. The presence or the development of hydrops, an obstruction of the right ventricular outflow tract, and the lung hypoplasia could be considered as signs of poor prognosis. A reliable differentiation between a patent pulmonary valve, pulmonary stenosis and pulmonary atresia in severe tricuspid regurgitation using modern Doppler means is difficult as seen in our studied group and in the literature.(ABSTRACT TRUNCATED AT 250 WORDS)