Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-12T22:09:52.213Z Has data issue: false hasContentIssue false
  • English
  • Français

The spectrum of fetal cardiac malformations

Published online by Cambridge University Press:  01 July 2011

Andrew C. Cook
Andrew C. Cook*
Affiliation:
Cardiac Unit, Institute of Child Health, University College London, London, UK
*
Correspondence to: Andrew C. Cook, Cardiac Unit, Institute of Child Health, University College London, 30 Guilford Street, London WC1 1EH. Tel: +44 20 7905 2295; Fax: +44 20 7805 2324; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Increasingly, paediatric cardiologists are called upon to diagnose cardiac malformations prenatally. In the main, the types of malformation seen during fetal life will be similar to those documented postnatally, but the frequency with which they are encountered, as well as the views that can be used for diagnosis, will be different. This review aims to describe the anatomic spectrum of malformations seen in 917 fetal hearts examined consecutively following prenatal diagnosis. The distribution of anomalies is illustrated in terms of a simple sweep through the fetal thorax passing from the four-chamber plane to the outflow tracts, and then to more cranial views of the mediastinum. Two-thirds of the anomalies described would have been detectable in the four-chamber plane. Some, such as tricuspid valvar abnormalities, will alter the normal appearances of the four-chambers dramatically. In terms of the overall spectrum, however, such obvious abnormalities only form a minor part of the total number. Others, such as atrioventricular septal defect, will often require closer inspection of intracardiac anatomy, but will make up a large proportion of the entire cohort. Up to one third of the anomalies in the series would have required views more cranial to the four-chamber plane of section. In these, it would have been necessary to examine the nature of the left ventricular outflow tract, the crossing of the two outflows, or else the arterial arches in order to secure detection. In the fetus, these and other planes must be considered by the echocardiographer in order completely to detect and document the entire spectrum of cardiac abnormalities likely to be encountered.

Keywords

Congenital cardiac malformationsfetal cardiologycardiac morphology
Type
Continuing Medical Education
Information
Cardiology in the Young , Volume 11 , Issue 1 , January 2001 , pp. 97 - 110
Copyright
Copyright © Cambridge University Press 2001

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Allan, LD, Sharland, GK, Milburn, A, Lockhart, SM, Groves, AM, Anderson, RH, Cook, AC, Fagg, NL. Prospective diagnosis of 1,006 consecutive cases of congenital heart disease in the fetus. J Am Coll Cardiol 1994 23: 1452–1458.CrossRefGoogle Scholar
2.Simpson, JM, Sharland, GK. Fetal tachycardias: management and outcome of 127 consecutive cases. Heart 1998 79: 576–581.CrossRefGoogle ScholarPubMed
3.van Engelen, AD, Weijtens, O, Brenner, JI, Kleinman, CS, Copel, JA, Stoutenbeek, P, Meijboom, EJ. Management outcome and follow-up of fetal tachycardia. J Am Coll Cardiol 1994 24: 1371–1375.CrossRefGoogle ScholarPubMed
4. Appendix. In: Allan, LD, Hornberger, LK, Sharland, GK (eds). Textbook of Fetal Cardiology, Greenwich Medical Media Ltd, London, 2000, pp 581.Google Scholar
5.Cook, AC, Fagg, NL, Ho, SY, Groves, AM, Sharland, GK, Anderson, RH, Allan, LD. Echocardiographic-anatomical correlations in aorto-left ventricular tunnel. Br Heart J 1995 74: 443–448.CrossRefGoogle ScholarPubMed
6.Allan, LD, Sharland, G, Cook, AC. Colour Atlas of Fetal Cardiology. Mosby-Wolfe, London, 1994.Google Scholar
7.Oberhoffer, R, Cook, AC, Lang, D, Sharland, G, Allan, LD, Fagg, NL, Anderson, RH. Correlation between echocardiographic and morphological investigations of lesions of the tricuspid valve diagnosed during fetal life. Br Heart J 1992 68: 580–585.CrossRefGoogle ScholarPubMed
8.Sharland, GK, Cook, AC. Pulmonary atresia with intact ventricular septum: Diagnosis in the fetus. In: Redington, AN, Brawn, WJ, Deanfield, JE, Anderson, RH (eds). The right heart in congenital heart disease. Greenwich Medical Media Ltd, London, 1998, pp 25–33.Google Scholar
9.Lang, D, Oberhoffer, R, Cook, A, Sharland, G, Allan, L, Fagg, N, Anderson, RH. Pathologic spectrum of malformations of the tricuspid valve in prenatal and neonatal life. J Am Coll Cardiol 1991 17: 1161–1167.CrossRefGoogle ScholarPubMed
10.Brann, S, Brawn, WJ, Raafat, F, Sreeram, N. Neonatal pulmonary vascular disease in hypoplastic left heart syndrome. Annals of Thoracic Surgery 1995 60: 433–434.CrossRefGoogle ScholarPubMed
11.Anderson, RH, Tynan, M. Editorial note: Description of complex forms of atrioventricular valvar atresia. Int J Cardiol 1991 30: 243–247.CrossRefGoogle Scholar
12.Freedom, RM, Smallhorn, JF. Univentricular atrioventricular connection. In: Freedom, RM, Benson, LN, Smallhorn, JF (eds). Neonatal Heart Disease, Springer-Verlag Ltd, London, 1992, pp 497–521.CrossRefGoogle Scholar
13.Anderson, RH, Ho, SY, Becker, AE. Anatomy of the human atri-oventricular junctions revisited. Anat Rec 2000; 260: 81–91.3.0.CO;2-3>CrossRefGoogle Scholar
14.Cook, AC, Allan, LD, Anderson, RH, Sharland, G, Fagg, NLR. Atrioventricular septal defect in fetal life – a clinicopathological correlation. Cardiol Young 1991; 1: 334–343.CrossRefGoogle Scholar
15.Huggon, IC, Cook, AC, Smeeton, NC, Magee, AG, Sharland, GK. Atrioventricular septal defects diagnosed in fetal life: associated cardiac and extra-cardiac abnormalities and outcome. J Am Coll Cardiol 2000; 36: 593–601.CrossRefGoogle ScholarPubMed
16.Allwork, SP, Anderson, RH. Developmental anatomy of the membranous part of the ventricular septum in the human heart. Br Heart J 1979; 41: 275–280.CrossRefGoogle ScholarPubMed
17.Sharland, G. What should be provided by a service for fetal cardiology? Cardiol Young 2000; 10: 625–635.CrossRefGoogle ScholarPubMed
18.Groves, AM, Fagg, NL, Cook, AC, Allan, LD. Cardiac tumours in intrauterine life. Arch Dis Child 1992; 67: 1189–1192.CrossRefGoogle ScholarPubMed
19.Dyck, JD, Freedom, RM. Aortic stenosis. In: Freedom, RM, Benson, LN, Smallhorn, JF (eds). Neonatal Heart Disease. Springer-Verlag Ltd, London, 1992, pp 357–373.CrossRefGoogle Scholar
20.Ettedgui, JA, Sharland, GK, Chita, SK, Cook, AC, Fagg, NLK, Allan, LD. Absent pulmonary valve syndrome with ventricular septal defect: role of the arterial duct. Am J Cardiol 1990; 66: 233–234.CrossRefGoogle ScholarPubMed
21.Bartelings, MM, Gittenberger De Groot, AC. The arterial orifice level in the early human embryo. Anat Embryol 1988; 177: 537–542.CrossRefGoogle ScholarPubMed
22.Yoo, SJ, Lee, YH, Cho, KS. Abnormal three-vessel view on sonography: a clue to the diagnosis of congenital heart disease in the fetus. Am J Roentgenol 1999; 172: 825–830.CrossRefGoogle Scholar
23.Hornberger, LK, Sahn, DJ, Kleinman, CS, Copel, J, Silverman, NH. Antenatal diagnosis of coarctation of the aorta: a multi-center experience. J Am Coll Cardiol 1994; 23: 417–423.CrossRefGoogle Scholar
24.Sharland, GK, Cook, AC. Hettotaxy syndromes/ Isomerism of the atrial appendages. In: Allan, LD, Hornberger, LK, Sharland, GK (eds). Textbook of Fetal Cardiology, Greenwich Medical Media Ltd, London, 2000, pp 333–346.Google Scholar