BACKGROUNDFoetal echocardiography has become a diagnostic method to detect foetal congenital heart disease with high probability. However, it is not only time consuming and but also difficult to visualize outflow tract of foetus early in the second trimester of pregnancy, even for an experienced obstetric ultrasonographer. Recently, many methods for screening foetal cardiac anomalies were explored, but much more work is needed to develop an effective and suitable screening method. The aim of this study was to investigate the clinical significance of utilising the ductus venosus (DV) Doppler examination and the four-chamber view of heart to screen for foetal cardiac malformation in early second trimester of pregnancy.

METHODSHeart and DV of 401 consecutive foetuses in early second trimester (12(+1) - 17(+6) weeks) in high risk pregnancies were examined with Acuson 128 xp/10 or Sequoia 512 ultrasound diagnostic systems. Absent or reversed flow during atrial contraction (A-wave) in the DV was defined as sufficiently abnormal to screen for foetal cardiac malformations. The foetal echocardiographic diagnosis was confirmed by postnatal echocardiography (or postmortem). The sensitivities of screening tests were compared among the three methods: DV Doppler examination, four-chamber view alone, and the combination of both techniques.

RESULTSSatisfactory examinations were obtained in 383/401 foetuses (95%). Thirty foetuses with cardiac abnormalities were confirmed by neonatal echocardiography (or postmortem). The sensitivity of DV Doppler examination or four-chamber view alone is 63% (19/30) and 60% (18/30), respectively. The sensitivity of combining information, DV Doppler flow waveform and four-chamber view, to screen for foetal cardiac malformation is 83% (25/30) and significantly better than that of either DV Doppler flow waveform or four chamber view alone (P < 0.05).

CONCLUSIONDoppler flow waveform of DV can be used to screen for foetal cardiac malformation early in the second trimester. Combining information from Doppler flow waveform of DV and four-chamber view will improve the overall sensitivity of the screening.

To investigate the value of echocardiography in the diagnosis of total anomalous pulmonary venous connection (TAPVC), 16 patients in our hospital were diagnosed to have TAPVC by echocardiography from year 1994 to 2001. In 11 cases the results of echocardiography were compared to those of surgery. Each patient was examined by using a combination of precordial, suprasternal and subcostal windows to visualize all the pulmonary veins and their drainage sites, common pulmonary venous trunk, and other associated abnormalities. Of the 16 cases, the drainage sites were as follow: supracardiac in 10, via vertical vein in 9, directly to superior vena cava in 1; cardiac in 5, via coronary sinus in 2, directly to right atrium in 3. Diagnoses were correctly made in all the 11 cases as confirmed by surgery. Echocardiography can also assess pulmonary arterial pressure and detect other associated abnormalities. It is concluded that echocardiography is the preferred examination method in the diagnosis of TAPVC before surgery. With careful examination using multiple windows and sections, TAPVC can be accurately diagnosed by echocardiography.
*Echocardiography, Doppler, Color ; Heart Defects, Congenital/*ultrasonography ; Pulmonary Veins/*abnormalities ; Pulmonary Veins/ultrasonography

Congenital heart disease(CHD) is the most common congenital abnormality in human fetus, accounting for more than half of deaths from congenital abnormalities in childhood. Fetal echocardiography has been shown to be able to identify the majority of structural cardiac abnormalities, and it has traditionally been reserved for pregnancies at high risk for CHD. Most neonates with CHD, however, have no identifiable risk factors. When a sonogram is performed during pregnancy for defined clinical reasons, a four-chamber view of the fetal heart is routinely performed. However, a four-chamber view of the fetal heart does not reliably detect the most common CHD such as ventricular septal defect, coarctation of the aorta, transposition of the great arteries, and tetralogy of Fallot. Therefore, the vast majority of cases of CHD are left undetected even in those women who have undergone an obstetric ultrasound. A high level of suspicion of the presence of CHD and attention to anatomic details should be part of every ultrasound examination, especially when involving lowrisk pregnancies, and it is currently recommended that only those fetuses with significant risk factors be referred for a targeted sonogram and fetal echocardiogram.
Aortic Coarctation ; Arteries ; Congenital Abnormalities ; Echocardiography* ; Female ; Fetal Heart ; Fetus ; Heart ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular ; Humans ; Infant, Newborn ; Pregnancy ; Risk Factors ; Tetralogy of Fallot ; Ultrasonography

The syndromes of left atrial isomerism and right atrial isomerism, called polysplenia and asplenia syndromes, respectively, consist of congenital heart defects with disturbances in normal left right isometry, and the etiology of atrial isomerism remains unclear. Right atrial isomerism is traditionally associated with severe cardiac defects, especially complete atrioventricular septal defect, transposition of great arteries, pulmonary atresia, and total anomalous pulmonary venous return. Recently, we encountered one case of asplenia diagnosed by prenatal ultrasonography. We report a case with brief review of the literatures.
Heart Defects, Congenital ; Heterotaxy Syndrome ; Isomerism ; Pulmonary Atresia ; Scimitar Syndrome ; Transposition of Great Vessels ; Ultrasonography, Prenatal*

We describe a case of an infant born at 39 weeks of gestation who was in the neonatal intensive care unit for postoperative management of congenital heart disease and underwent bedside ultrasound-guided percutaneous cystostomy to treat an iatrogenic urethral injury. The procedure was uneventful, successful, and no complications were noted. This case demonstrates that this procedure is safe and minimally invasive. Indications, contraindications, techniques, potential complications, and the safety of performing this procedure in a bedside setting are discussed.
Cystostomy* ; Heart Defects, Congenital ; Humans ; Infant* ; Infant, Newborn ; Intensive Care, Neonatal* ; Pregnancy ; Ultrasonography

OBJECTIVE: To investigate the clinical significance of 3-vessel subsequence view in prenatal screening and diagnosis of fetal congenital heart disease. METHODS: The 3-vessel subsequence view of 231 fetuses with congenital heart disease was obtained with Sequoia 512, Voluson 730 and E8 color Doppler ultrasonographic diagnostic system. RESULTS: Of the 231 consecutive fetuses with congenital heart defects (CHD), 169 (73%) had at least 1 abnormality on the 3-vessel subsequence view. When ventricl septal defects and so on were excluded, the detection rate increased to 91%. Some defects had several abnormalities visualized at the 3-vessel subsequence view. CONCLUSION The 3-vessel subsequence view has high detection rate in identifying the presence of CHD.
Female ; Fetal Diseases ; diagnostic imaging ; Fetus ; Heart Defects, Congenital ; diagnostic imaging ; Humans ; Pregnancy ; Ultrasonography, Prenatal

PURPOSE: The aims of this study was to assess the indication, diagnostic, accuracy and prognostic influence of fetal echocardiography. METHODS: From 1995 to 1999, 283 pregnancies were evaluated with fetal echocardiography at Dong-A University Hospital. We reviewed medical records included indication, fetal echocardiographic findings, postnatal echocardiographic findings, methods of treatment and outcome of prenataly diagnosed patients. RESULTS: Family history of congenital heart disease led to 32.2% of all fetal echocardiography with a detection rate of 2.1%. The most important indication of fetal echocardiography was suspected heart anomaly on a screening obstetric ultrasonography yield(detection rate : 61.7%). Nearly all forms of congenital heart disease were detected in utero. However several forms of structural congenital heart disease such as ventricular septal defect and anomalous pulmonary venous return were difficult to diagnosis in utero. In 13 fetuses arrhythmias were detected; the most common arrhythmia was premature atrial contraction. Improving the outcomes of patients with prenatal diagnosis are so far controversial because of the small number of cases and increased termination rates of fetuses with congenital heart disease. CONCLUSION: Fetal echocardiography has emerged as a reliable tool for prenatal detection of congenital heart disease and arrhythmia. But the effect of prenatally detected congenital heart disease on the management and the outcome of pregnancy can be controversial and legal problems may be important issues in the future.
Arrhythmias, Cardiac ; Atrial Premature Complexes ; Diagnosis ; Echocardiography* ; Fetus ; Heart ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular ; Humans ; Mass Screening ; Medical Records ; Pregnancy ; Prenatal Diagnosis ; Scimitar Syndrome ; Ultrasonography

The estimated incidence of conjoined twins is one in 50,000 births, however, over 60% are stillborn, making the observed incidence around one per 200,000 live-births. Thoracopagus is the most common variety of conjoined twins accompanying with congenital heart disease 75%, fusion of alimentary tracts 50%, single external biliary tract 25%. Approximately 90% of thoracopagus conjoined twins are not candidates for surgical separation due to the high degree of cardiac union and the complexity of cardiovascular anomalies. With improvement in prenatal diagnosis and routine ultrasound monitoring of pregnancies, these cases are more commonly being diagnosed prenatally. Accurate diagnosis of the shared anatomy and associated malformations is crucial for counseling of the affected families regarding outcome as well as planning potential postnatal surgical separation. We experienced a case of thoracopagus with single conjoined heart that was diagnosed by ultrasonography at 15 weeks of gestation in 33 years old woman. So we present this case with a brief review of literatures.
Adult ; Biliary Tract ; Counseling ; Diagnosis ; Female ; Heart ; Heart Defects, Congenital ; Humans ; Incidence ; Parturition ; Pregnancy ; Prenatal Diagnosis ; Twins, Conjoined ; Ultrasonography

We experienced a case of Ebstein's anomaly prenatally by fetal sonography. Ebstein's anomaly is a rare congenital heart defect characterized by abnormally downward displacement of the septal and posterior leaflets of the tricuspid valve. In the absence of tricuspid regurgitation, this condition may be completely asymptomatic. On the other hand, symptomatic newborns often develop life-threatening congestive heart failure. A 30-year-old multiparous woman was referred for the evaluation of fetal cardiac defect at 26th gestational week from a private clinic. Fetal ultrasonography showed markedly enlarged right atrium and downward displacement of tricuspid valve into the right ventricle. After discussion with the patient, the pregnancy was terminated and Ebstein's anomaly was confirmed by autopsy.
Adult ; Autopsy ; Ebstein Anomaly* ; Female ; Hand ; Heart Atria ; Heart Defects, Congenital ; Heart Failure ; Heart Ventricles ; Humans ; Infant, Newborn ; Pregnancy ; Tricuspid Valve ; Tricuspid Valve Insufficiency ; Ultrasonography, Prenatal

Holt-Oram Syndrome is an autosomal dominant disorder characterized by the association of upper-limb abnormalities and congenital heart disease. A woman with no family history of genetic disease underwent antenatal sonography at 27 weeks' menstrual age to screen for fetal anomalies. Ultrasonography revealed abnormalities in the upper limbs. The limb abnormalities included abscence of bilateral thumbs and radius: the left humus was short. Pregnancy termination was performed. The postnatal chromosomal analysis revealed a normal 46XX karyotype and the autopsy finding confirmed the Holt-Oram syndrome. We report a case of Holt-Oram Syndrome in fetus with unaffected parents with brief of the literatures.
Autopsy ; Extremities ; Female ; Fetus ; Heart Defects, Congenital ; Humans ; Karyotype ; Parents* ; Pregnancy ; Radius ; Soil ; Thumb ; Ultrasonography* ; Upper Extremity