ECHOCARDIOGRAPHY Prenatal diagnosis and postnatal management of critical aortic stenosis

Fetal echocardiography has yet to have an impact on the treatment of congenital heart disease. Critical aortic valve stenosis was diagnosed by echocardiography before birth in a 35 week gestation fetus. The risks to the fetus and mother associated with prolonged rupture of membranes prompted their transport to a hospital with cardiac surgical and high-risk perinatal facilities. Prenatal and postnatal echocardiographic findings agreed regarding the diagnostic criteria for critical aortic stenosis and primary forms of cardiomyopathy were excluded. Results of fetal Doppler examination were consistent with valvular aortic stenosis and excluded mitral regurgitation. Determination of the left ventricular size excluded ventricular hypoplasia. The infant was delivered by cesarean section and underwent successful emergency aortic valvotomy at 12 hr of age. Fetal echocardiography, in combination with a multidisciplinary postnatal approach, can be used in the successful treatment of a severe form of congenital heart disease. Circulation 75, No. 3, 573-576, 1987. TECHNIQUES of fetal echocardiography are now being evaluated to define their accuracy in prenatal diagnosis of congenital heart disease. Early results show that defects that are discovered in utero often are severe and are associated with either other major defects, such as hydrocephaly, omphalocele, or a genetic abnormality, or with insufficiency of the atrioventricular valve, hydrops fetalis, or complete heart block. The natural history of congenital heart defects diagnosed by fetal echocardiography has yet to be fully explored, but the high mortality in this selected group has led to pessimism about the possible benefits of efforts in this field.1'2 Therefore, the major impact of fetal echocardiography up to the present time has been (1) reassurance for families to which a previous child with a complex defect has been born when the fetal echocardiographic findings appear normal, and (2) screening From the Lillie Frank Abercrombie Section of Pediatric Cardiology, Departments of Pediatrics and Obstetrics/Gynecology, Baylor College of Medicine, and The Texas Heart Institute, St. Luke's Episcopal Hospital, Texas Children's Hospital, and Jefferson Davis Hospital, Harris County Hospital District, Houston. Supported in part by grant No. G-410 from the American Heart Association, Texas Alfiliate, New Investigator Award HL31153 from the NHLBI, Public Health Service grant RR-05425 from the NIH, United States Public Health Services, and grant RR-00188 from the General Clinical Research Branch, NIH. Address for correspondence: James C. Huhta, M.D., Pediatric Cardiology, 1-253, Texas Children's Hospital, 6621 Fannin St., Houston, TX 77030. Received Aug. 12, 1986; revision accepted Nov. 13, 1986. Vol. 75, No. 3, March 1987 for congenital heart disease if a defect is suspected early in gestation. This report shows how fetal echocardiography may affect the treatment of congenital heart disease.