Accuracy of fetal echocardiography in high-risk patients

To assess the accuracy of prenatal diagnosis of congenital heart defects and rhythm abnormalities. Between September 1995 and September 1996, 148 fetal echocardiographic studies were performed in a high risk population for congenital heart disease by a team of a pediatric cardiologist and a perinatologist. Standard four chamber, right and left ventricular outflow tracts, and ductal and aortic arch views were obtained for two-dimensional sector scanning and Doppler analysis. Cardiac rhythm was studied through pulsed Doppler assessment of inflow-outflow in the left ventricle. All patients were scheduled for a post-natal echocardiographic control. There were 105 (71%) normal and 43 (29%) abnormal studies, of which 31 (72%) had rhythm abnormalities and 12 (28%) had anatomic defects. Forty one of 43 cases with congenital heart disease were correctly diagnosed (sensitivity 95%) and one false-positive diagnosis was made, giving a specificity of 99%. A high yield of either congenital heart defects (73%) or fetal arrhythmias (70%) was obtained when studies were referred for abnormal scans at level 1. A high degree of diagnostic accuracy is obtained when fetal echocardiographic examination is performed comprehensively in a high-risk population for congenital heart disease.