Fetal echocardiography — A recent four year experience from a single urban center

The purpose of this study was to determine the yield of fetal echocardiography based on indications for referral and to establish the incidence of structural heart disease noted in a diverse urban population. A retrospective review of our Pediatric Echocardiography Laboratory database was undertaken from March 2010 to June 2014. Demographic information, indications for referral and prenatal diagnoses were recorded. The diagnosed cardiac anomalies were classified into structural and rhythm abnormalities and the former was divided into major and minor anomalies. We compared the number of fetal echocardiograms performed during this four-year period to a similar four-year period, a decade earlier. Also, we compared the number of cardiac admissions to the neonatal intensive care unit in these two periods. 3623 fetal echocardiograms were performed on 2953 patients between 2010 and 2014. Fetal indications accounted for 70% of referrals. Overall, yield of congenital heart disease was 11.5%; 6.8% from maternal and 13.4% from fetal indications. Abnormal obstetrical fetal ultrasound was associated with congenital heart disease in 13.9% of cases. Of 336 fetuses with congenital heart disease, 119 were major and 47 were critical. 80% of all congenital heart diseases (273 of 336) and 90% of major and critical heart disease were found in those referred for fetal indications. Approximately half (24 of 47, 51%) of the critical congenital heart disease involved defects with varying degrees of left heart hypoplasia. Compared to a previous period, there was an increase in FE and neonatal intensive care unit admissions with cardiac diagnoses. However, critical congenital heart disease detected postnatally fell from 28.8 to 12.8% (P = 0.001). Yield of fetal echocardiograms is higher for fetal versus maternal indications. At our center, increase in prenatal detection of critical congenital heart disease may have resulted in reduction in congenital heart disease diagnosed in the neonatal intensive care unit.