Value of fetal echocardiography in diagnosis of congenital heart disease in a Serbian university hospital.

Objective: Ultrasound examination for each and every pregnancy is being accepted as a standard practice worldwide, and prenatal ultrasound diagnosis of congenital heart disease (CHD) is improving due to both staff education and ultrasound equipment modernization. The objective of this study was to estimate the value and accuracy of fetal echocardiography for diagnosis of fetal CHD in a large tertiary referral center for obstetrics and gynecology.

Methods: This study was based on a prospective follow-up of 27,051 consecutive patients at the Institute of Ob/Gyn, Belgrade, during 1999-2003. Out of this population a total of 517 (1.9%) patients were selected for fetal echocardiography. The final diagnosis of congenital heart disease was confirmed or rejected on the basis of autopsy and histopathological findings, for the dead fetuses and newborns, or on the basis of neonatal echocardiography (followed by surgery/invasive diagnostic procedure), for the living neonates.

Results: From the total population analyzed, there was 71 gravida (0.26%) with congenital fetal heart disease. In that study group, the most frequent cardiac anomalies were complex congenital heart diseases. Analyzing the outcome, there were 67.6% cases with fetal CHD who delivered live neonates. Out of the 73 fetuses/neonates with CHD, abnormal karyotype was detected in only 9 cases. The parameters of the diagnostic value of fetal echocardiography were as follows: sensitivity 94.4%, specificity 99.8%, positive predictive value 98.5%, negative predictive value 99.1%, and overall diagnostic accuracy 99.0%.

Conclusion: Fetal echocardiography has a very high diagnostic accuracy, commending referral of suspected patients to large tertiary referral centers.