Objective. To describe the experience of a tertiary center in Brazil to which patients are referred whose fetuses are at increased risk for congenital heart diseases (CHDs). Methods. This was a cross-sectional observational study. The data was collected prospectively, during the year 2012, through a screening protocol of the fetal heart adapted from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guideline. We performed a fetal echocardiogram screening for all pregnant women who were referred to the fetal cardiology outpatient obstetrics clinic of a university hospital. The exams were classified as normal or abnormal. The cases considered abnormal were undergone to a postnatal echocardiogram. We categorized the abnormal fetal heart according to severity in “complex,” “significant,” “minor,” and “others.” Results. We performed 271 fetal heart screening. The incidence of abnormal screenings was 9.96% (27 fetuses). The structural CHD when categorized due to severity showed 48.1% ( ) of “complex” cases, 18.5% ( ) “significant” cases, and 7.4% ( ) “minor” cases. The most common referral reason was by maternal causes (67%) followed by fetal causes (33%). The main referral indication was maternal metabolic disease (30%), but there was just one fetus with CHD in such cases (1.2%). CHDs were found in 19/29 fetuses with suspicion of some cardiac abnormality by obstetrician (65.5%). Conclusion. We observed a high rate of CHD in our population. We also found that there was higher incidence of complex cases. 1. Introduction Congenital heart diseases (CHDs) are the most common abnormalities in fetuses, being six times more common than chromosomal abnormalities and four times more common than neural tube defects [1]. The incidence of CHD with intrauterine diagnosis ranges from 2.4% to 54% [2–7]. Some countries have high incidence of CHD because they have instituted an organized policy to perform heart screening by ultrasound systematically [8–10]. A detail evaluation of the fetal heart optimizes the diagnosis of CHD [11]. This provides an appropriate prenatal and postnatal planning, enabling an improvement in neonatal morbidity and surgical outcome [1, 12–15]. Therefore, there is an increasing interest in improving detection of the cardiac defects. There are many epidemiological and ultrasonographic data reported [2–7]; however, to the best of our knowledge, there are no published Brazilian epidemiological data. Our aim is to describe the experience of a tertiary center in Brazil to which patients are referred whose fetuses are at
References
[1]
J. S. Carvalho, E. Mavrides, E. A. Shinebourne, S. Campbell, and B. Thilaganathan, “Improving the effectiveness of routine prenatal screening for major congenital heart defects,” Heart, vol. 88, no. 4, pp. 387–391, 2002.
[2]
Z. Yu, Y. Xi, W. Ding et al., “Congenital heart disease in a Chinese hospital: pre- and postnatal detection, incidence, clinical characteristics and outcomes,” Pediatrics International, vol. 53, no. 6, pp. 1059–1065, 2011.
[3]
N. Ozbarlas, S. Erdem, O. Kü？ükosmano？lu, et al., “Prevalence and distribution of structural heart diseases in high and low risk pregnancies,” Anadolu Kardiyol Derg, vol. 11, pp. 125–130, 2011.
[4]
J. E. Lee, K.-L. Jung, S.-E. Kim et al., “Prenatal diagnosis of congenital heart disease: trends in pregnancy termination rate, and perinatal and 1-year infant mortalities in Korea between 1994 and 2005,” Journal of Obstetrics and Gynaecology Research, vol. 36, no. 3, pp. 474–478, 2010.
[5]
M. K. Friedberg, N. H. Silverman, A. J. Moon-Grady et al., “Prenatal detection of congenital heart disease,” Journal of Pediatrics, vol. 155, no. 1, pp. 26.e1–31.e1, 2009.
[6]
S. A. B. Clur, P. M. van Brussel, I. B. Mathijssen, E. Pajkrt, J. Ottenkamp, and C. M. Bilardo, “Audit of 10 years of referrals for fetal echocardiography,” Prenatal Diagnosis, vol. 31, no. 12, pp. 1134–1140, 2011.
[7]
A. Galindo, I. Herraiz, D. Escribano, D. Lora, J. C. Melchor, and J. de la Cruz, “Prenatal detection of congenital heart defects: a survey on clinical practice in Spain,” Fetal Diagnosis and Therapy, vol. 29, no. 4, pp. 287–295, 2011.
[8]
E. Garne, C. Stoll, and M. Clementi, “Evaluation of prenatal diagnosis of congenital heart diseases by ultrasound: experience from 20 European registries,” Ultrasound in Obstetrics and Gynecology, vol. 17, no. 5, pp. 386–391, 2001.
[9]
H. Dolk, M. Loane, and E. Garne, “Congenital heart defects in Europe: prevalence and perinatal mortality, 2000 to 2005,” Circulation, vol. 123, no. 8, pp. 841–849, 2011.
[10]
International Society of Ultrasound in Obstetrics #38; Gynecology, “Cardiac screening examination of the fetus: guidelines for performing the “basic” and “extended basic” cardiac scan,” Ultrasound in Obstetrics & Gynecology, vol. 27, pp. 107–113, 2006.
[11]
E. A. Júnior, L. C. Rolo, L. M. Nardozza, and A. F. Moron, “Fetal cardiac evaluation by 3D/4D ultrasonography (STIC): what is its real applicability in the diagnosis of congenital heart disease?” The Revista Brasileira de Cirurgia Cardiovascular, vol. 28, no. 1, pp. 3–5, 2013.
[12]
L. Allan, “Prenatal diagnosis of structural cardiac defects,” American Journal of Medical Genetics C, vol. 145, no. 1, pp. 73–76, 2007.
[13]
C. Bull, “Current and potential impact of fetal diagnosis on prevalence and spectrum of serious congenital heart disease at term in the UK,” The Lancet, vol. 354, no. 9186, pp. 1242–1247, 1999.
[14]
J. I. E. Hoffman, “Incidence of congenital heart disease: II. Prenatal incidence,” Pediatric Cardiology, vol. 16, no. 4, pp. 155–165, 1995.
[15]
A. H. de Souza, L. da Fonseca, S. M. Franchi, A. C. Lianza, J. F. Baumgratz, and J. P. da Silva, “The hypoplastic left heart syndrome is not a risk factor for Fontan operation,” Brazilian Journal of Cardiovascular Surgery, vol. 25, no. 4, pp. 506–509, 2010.
[16]
W. Lee, L. Allan, J. S. Carvalho et al., “ISUOG consensus statement: what constitutes a fetal echocardiogram?” Ultrasound in Obstetrics and Gynecology, vol. 32, no. 2, pp. 239–242, 2008.
[17]
S. Hunter, A. Heads, J. Wyllie, and S. Robson, “Prenatal diagnosis of congenital heart disease in the northern region of England: benefits of a training programme for obstetric ultrasonographers,” Heart, vol. 84, no. 3, pp. 294–298, 2000.
[18]
C. Wren, S. Richmond, and L. Donaldson, “Temporal variability in birth prevalence of cardiovascular malformations,” Heart, vol. 83, no. 4, pp. 414–419, 2000.
[19]
J. C. Guitti, “Epidemiological characteristics of congenital heart diseases in Londrina, Paraná south Brazil,” Arquivos Brasileiros de Cardiologia, vol. 74, no. 5, pp. 395–404, 2000.
[20]
L. T. V. Boas, E. P. Albernaz, and R. G. Costa, “Prevalence of congenital heart defects in patients with Down syndrome in the municipality of Pelotas, Brazil,” Jornal de Pediatria, vol. 85, no. 5, pp. 403–407, 2009.
[21]
N. I. Miyague, S. Meyer Cardoso, F. Meyer et al., “Epidemiological study of congenital heart defects in children and adolescents. Analysis of 4,538 cases,” Arquivos Brasileiros de Cardiologia, vol. 80, no. 3, pp. 269–278, 2003.
[22]
R. Bader, “Abnormal cardiac findings in prenatal sonographic examination: an important indication for fetal echocardiography?” Journal of the Saudi Heart Association, vol. 20, pp. 29–33, 2008.
[23]
S. Ozkutlu, T. Akca, G. Kafal？, and S. Beksa？, “The results of fetal echocardiography in a tertiary center and comparison of low and high-risk pregnancies for fetal congenital heart defects,” Anadolu Kardiyol Derg, vol. 10, pp. 263–269, 2010.
[24]
S. M. Emam, “High prevalence of complex congenital cardiac anomalies detected by fetal echocardiography in a cohort of Saudi women referred for prenatal assessment,” Journal of the Egyptian Society of Parasitology, vol. 42, no. 2, pp. 281–290, 2012.
