Prenatal cardiology

Prirođene srčane grješke uzrokom su 7 % svih novorođenačkih smrti. Većina tih smrti događa se kod neliječene djece. Fetalna ehokardiografija omogućava rano otkrivanje prirođenih srčanih grješaka što omogućava i istovremeno liječenje PSG intrautero ili u ranoj neonatalnoj dobi. Cilj ovog istraživanja jest istražiti vrijednost fetalne ehokardiografije u poboljšanju prenatalnog otkrivanja PSG. Ovo retrospektivno kohortno istraživanje je rađeno na uzorku od 1380 trudnica, upućenih od ginekologa, koje su pregledane u Fetalnoj kardiološkoj ambulanti KBC-a Zagreb u razdoblju od 1.1.2012.do 1.1.2015. Učinjen je ukupno 2001 pregled zato što su neke trudnice pregledane 2 i više puta, iz čega vidimo godišnji prosjek od 600 do 670 pregleda. Većinu indikacija određivali su opstetričari, manji dio je upućen od strane reumatologa, genetičara ili drugih subspecijalista dok je dio trudnica tražilo pregled rutinski prema vlastitoj želji. U 14.2% trudnica postavljena je sumnja na srčanu bolest (197/1380) od kojih su najčešće bile: VSD 25%, AVS 6.12% , CMP 10.7%, aritmije 14.78%, CoA 8.16%, BAV 3.02% te složene PSG 15.28%. Patološki nalaz je puno češći kod žena koje su poslane na pregled s određenom indikacijom, nego kod onih koje su poslane na rutinski pregled. Od ovih 197 djece, njih 84 je nakon rođenja praćeno u našoj klinici pri čemu je ispravno postavljena prenatalna dijagnoza kod 45 djece što pokazuje osjetljivost testa od 53%. Iz ovih rezultata dolazimo do zaključka da bi se trudnicama s GD i aritmijama kao propisanim indikacijama trebala raditi prenatalna ehokardiografija radi detekcije PSG, slično ostalim istraživanjima na ovom području, u preko 50% slučajeva ultrazvukom je pravilno postavljena dijagnoza. Iz toga zaključujemo da je fetalna ehokardiografija korisna metoda u detekciji PSG što omogućava ranu intervenciju i liječenje grješaka.Complex heart malformations cause congenital heart disease (CHD) responsible for 7% of all deaths in newborns. Most of these deaths occur in untreated children. Fetal echocardiography (FE) enables early detection of CHD, allowing for early intervention. The aim of this study was to determine the value of the FE in improvement of prenatal detection of CHD. This retrospective cohort study involved 1380 pregnant women examined in the Fetal cardiology clinic in the University hospital Zagreb between 1st January 2012 and 1st January 2015, after being referred by their obstetrician. Women were examined on 2001 examination which shows us the annual number of examinations that goes from 600 to 670 examinations. Most of the women were sent by their obstetricians, some were sent by geneticists, internists and other subspecialists while smaller number of women were examined on their own request. The incidence of CHD in this study equaled 14.2%, 197 sick child form 1380 examined children. The most common CHD were: VSD 25%, complex CHD 15.28%, AVS 6.12% , CMP 10.7%, arrhythmia 14.78%, CoA 8.16% and BAV 3.02%. CHD were more common in children whose mothers were sent onan examination because of the specific indications then in children whose mothers were examined as a routine examination. 84 of 196 children with CHD detected by FE were examined in our clinic after birth. The diagnosis was confirmed in 45 of them, showing the sensitivity of FE scanning for CHD of 53%. In conclusion, only pregnant women with indications for FE should be scanned for CHD. Similarly to other studies in this field, over 50% percent of the cases of CHD were correctly identified by FE in this study. Therefore, we claim that FE is a useful method in determining CHD in fetuses, allowing for early intervention after birth