Ultraschall Med 2008; 29 - S1_OP7
DOI: 10.1055/s-2008-1080762

Haemodynamic examination of fetal cardiopathies assessed by fetal color-coded Doppler echocardiography – Examination of fetal cardiac function by fetal echocardiography

M Katona 1, H Orvos 2, E Horvath 2, A Pal 2
  • 1Department of Pediatrics, Neonatal Intensive Care Unit, Szeged, Hungary
  • 2Department of Pediatrics and Department Obstetrics and Gynecology, Department of Genetics, University of Szeged, Hungary, Szeged, Hungary

Anatomy of the fetal heart examined by fetal echocardiography does not always reflect the severity of a cardiopathy. Abnormal haemodynamics could be detected even in a structurally normal fetal heart affected with hypoxia, infection, maternal drug therapy, etc. Heart failure, decreased cardiac output, abnormal flow in the great arteries and veins can be precisely measured by fetal color Doppler-echocardiography (FCDE).Aim: to evaluate the fetal cardiac function of fetuses with congenital heart defect (CHD) and with structurally normal heart by FCDE.

Patients, methods: during 8 years 2023 pregnants were examined on the 16–38 gest. weeks, 61 fetuses with cardiopathies underwent detailed FCDE examination. Doppler velocimetry of the ductus arteriosus (DA), ductus venosus (DV), presence of tricuspid insufficiency (TI), mitral insufficiency (MI) and aortic flow (AF) and pulmonary flow (PF) were assessed. Equipment: ACUSON XP–128 Doppler-echocardiograph with 5–7 MgHz transducers.

Results: 38 CHD-s, 10 fetal hydrops, 3 endocardial fibroelastosis (CMP), 7 sustained tachycardias (ST) and 2 twin-to-twin transfusions (TTT), 1 case of fetal DA constriction were diagnosed. TI, retrograde AF and inverted DV flow were found in hypoplastic left heart syndrome (9 cases), severe MI in 3 CMP-s, decreased PF was measured in 2 right heart obstructions. Simultaneous evaluation of left ventricular inflow and outflow was successful in diagnosing the origin of ST, requiering antenatal medication (Digoxin, Verpamil, or both). MI and/or TI was detected in 10 fetal hydrops and in 2 TTT cases. A fetal DA constriction was stopped after cessation of maternal Indomethacin therapy. There were 20 deaths (9 abortions, 1 in utero death and 10 postnatal deaths), 11 neonates underwent cardiac surgery.

Conclusions: 1. Segmental analysis of the fetal heart does not always exclude severe fetal cardiopathy, so FCDE must be performed even if cardiac morphology is normal.

2. Haemodynamic examination of the fetal heart provides clues for the induction of antenatal therapy/intervention or postnatal cardiac surgery.

3. Severe TI and/or MI and/or reverse DV flow in fetuses with CHD was predictive for increased morbidity and mortality.

congenital heart defect - fetal echocardiography - fetal therapy