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Long-term experience with the prenatal diagnosis of cardiac anomalies in high-risk pregnancies in a tertiary center.

BACKGROUND
The aim of this study was to analyze the role of the prenatal diagnosis of cardiac anomalies in our center.


METHODS
The data of 5540 pregnant women at risk for congenital heart disease and studied at fetal echocardiography between 1984 and 2002, with complete follow-up were retrospectively analyzed.


RESULTS
There was a progressive gradual increase in the number of cases examined per year; 670 fetuses (12% of the population) had congenital heart disease, 6.3% of the milder lesions were not detected. A cardiac arrhythmia was diagnosed in 284 fetuses. Extracardiac and chromosomal anomalies were associated in 23.7 and 14.6% respectively. Recurrence of congenital heart disease was 4.1%. One hundred and seventy-four patients (26%) opted for pregnancy termination; of the 496 fetuses whose parents decided to continue with pregnancy, 10.1% died in utero, 33.7% postnatally and 56.2% survived. The post-surgical mortality was 30.4%. Negative prognostic factors were associated anomalies, heart failure and complex congenital heart disease. Twenty-nine out of 33 fetuses with persistent tachyarrhythmias treated in utero survived; fetuses with complex and isolated atrioventricular block had a 75 and 11.1% mortality.


CONCLUSIONS
Prenatal diagnosis was useful in the management of pregnancy and a planned birth and was life-saving in case of tachyarrhythmia.