Outcome of fetuses with heart disease diagnosed in utero
Hospital for Children and
Adolescents, Division of Pediatric Cardiology, University of
Helsinki, Stenbackinkatu 11, 00290 Helsinki,
Finland
Correspondence to: Dr Marianne Eronen.
Accepted 30 January
1997
OBJECTIVE
To review the outcomes of 193 fetuses
with cardiac abnormalities detected by echocardiography.
METHODSA total of 422 fetuses between 16 and 41 gestational weeks, referred to paediatric cardiologists for detailed
echocardiography, were included in this study.
RESULTSStructural heart defects were found in 55 (28%), isolated arrhythmia in 105 (54%), and other non-structural
abnormalities (dilated cardiomyopathy, hypertrophic cardiomyopathy,
aneurysm of the foramen ovale, isolated pericardial effusion or
echogenic foci) in 33 (17%) of 193 fetuses. Total mortality was 26%.
The prognosis was poor in fetuses with structural heart defects; 37 of
55 cases (67%) died in utero or postnatally. Chromosomal abnormality was associated with structural heart defect in 38% of fetuses, of whom
38% died. Among fetuses with isolated arrhythmia survival was 95%.
Poor outcome was associated with complete heart block (n=14) in 2 (14%) fetuses with hydrops and heart rate of less than 55 per minute,
and with supraventricular tachycardia (n=21) in three (14%) neonates
delivered prematurely at a mean gestational age of 33 weeks.
Furthermore, nine of 12 fetuses (75%) with structural heart defects
and arrhythmia died. Among fetuses with non-structural cardiac
abnormalities, survival was 73%. Poor outcome was evident in fetuses
with dilated cardiomyopathy in eight of 13 (62%) and with hypertrophic
cardiomyopathy in one of eight (13%) of cases.
CONCLUSIONSFactors associated with a poor
prognosis were: structural heart defect associated with chromosomal
abnormality or arrhythmia, congestive heart failure associated with
supraventricular tachycardia or complete heart block, especially if
delivery occurs preterm; and fetal hydrops with congestive heart
failure and atrioventricular valve regurgitation.
© 1997 by Archives of Disease in Childhood
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