Accuracy of the Fetal Echocardiography in the High Risk Pregnancies

When introduced in diagnostics, two-dimensional (2D) ultrasound revolutionized many fields of clinical medicine.1,2 Among them, the cardiology gained a huge advantage of 2D ultrasonography for postnatal diagnostics and treatment of congenital cardiac defects. Jan Donald, the father of the modern obstetrical ultrasonography, could not predict how helpful and significant ultrasonography will become for the prenatal diagnosis of fetal cardiac problems.1,2 About twenty-five years ago the significance of prenatal diagnosis of congenital heart defects (CHDs) was considered very important for the prognosis of the fetus, and outcome of pregnancy, possibility of the postnatal correction or lifesaving intervention and prediction of the life quality of the newborn and the family. The incidence of CHD is estimated to be 0.8 in 1000 liveborn infants, and therefore this new possibility to diagnose them prenatally, has also important public-health implications.3-5 Another question, raised but so far not solved during the development of fetal echocardiography, was that screening of CHD is necessary for all, not only for high-risk pregnancies.6 Very important criterion for the screening method is its simplicity, good sensitivity and specificity, acceptable reliability and low costs.7,8 It was revealed that sensitivity of the fetal echocardiography could be improved by visualization of four-chamber view and depiction of great arteries outflow tracts in the same fetus.9 Is the education of screeners alone sufficient to achieve that goal of the utmost importance for the improvement of fetal echocardiography as a screening method? The answer to that question is still unequivocal, because improvements of ultrasound technology and telemedicine are opening the new and promising possibilities even for those who are not experts.10-14 When introduced, threeand four-dimensional (3D and 4D) echocardiography was quite new and exciting possibility in the fetal cardiology.12-14 Medications for the rhythm disturbances of the fetal heart have been used successfully for many years. Prenatal interventions, very rarely performed on fetal heart, are becoming more available with development of new nonsurgical methods of the cardiac defect repair.15 The question is where is development of fetal cardiology headed? At the beginning of 1990s, the first trimester transabdominal or transvaginal route of the assessment of fetal heart was developed in order to define fetal well-being and possible aneuploidy.6,16-21 An increasing rate of terminations of pregnancies will take place with the earlier diagnosis of CHD. In those who will survive, prenatal interventions will be possible in some cases while in the others, the prognosis will be improved by the early lifesaving postnatal intervention in the cardiac tertiary centers.15,22 The aim of the chapter is to give a brief overview on development of promising field of fetal echocardiography.