Foetal echocardiography: tool to predict the future of patients with congenital heart defects?

Antepartum obstetrical ultrasonic evaluation is nowadays commonly used in order to detect congenital anomalies. As congenital heart disease is the most frequently encountered congenital anomaly, cardiac examination is of paramount importance to identify defects on time. The advantage of foetal echocardiography is that ultrasound energy can be applied safely in an evolving fetus and that cardiac structures can be studied early in pregnancy (from 10 to 12 weeks by the vaginal approach, and from 16 to 18 weeks using the transabdominal approach). Failures to diagnose congenital heart defects correctly are caused by multiple variables including ultrasound technology, sonographer experience, and motheror foetal-related factors such as gestational age, foetal intrauterine position, or polyhydramnios. As congenital heart malformations are often associated with other cardiovascular and/or extracardiac malformations, extensive ultrasonic evaluation of the fetus is mandatory in case of a congenital heart defect. In their interesting study, Kaguelidou and co-workers present the impact of prenatal diagnosis on postnatal outcome in a large series of patients prenatally diagnosed with either tetralogy of Fallot or pulmonary atresia with ventricular septal defects. In common with with other studies, they report a high incidence of extracardiac malformations (46%), abnormal karyotyping (11%) and 22Q11 deletions (18%) in the embryos diagnosed to have either Fallot’s tetralogy or pulmonary atresia with ventricular septal defects. No relationship between chromosomal anomalies and postnatal outcome was established; the majority of pregnancies with chromosomal anomalies were terminated prematurely and the main reason for death of the liveborn children was the presence of extracardiac anomalies. Impact of foetal echocardiography