|FETAL ECHOCARDIOGRAPHY FOR ANTENATAL DETECTION OF CONGENITAL HEART DISEASE|
February 2003 Contents - Table de matières fevrier 2003, Can Assoc Radiol J 2003;54(1):56-60
2 D Echo in children with the traditional 4-chamber view of the heart had a detection rate for cardiac disease in the range of 5%-50%. The addition of short and long axis views increased detection rates to over 30% and inclusion of the outflow tracts increased rates to 70%-80%. The addition of color and pulse-wave Doppler imaging further increased detection rates to over 90%. This enables the assessment of both cardiac function and velocity and direction of blood flow in the cardiac chambers, across the atrioventricular and semilunar valves and in the aortic and pulmonary outflow tracts.
Why Should You Scan for Fetal Cardiac Malformations?
Most infants (up to 80%) with cardiac malformations are born to mothers with no known risk factors (low-risk patient). Classical risk factors for congenital heart disease (i.e. maternal disease including infection, maternal drug ingestion, previous fetus with a congenital heart defect or syndrome) are usually absent. Thus, detection is dependent on sensitive prenatal screening protocols.
Association with chromosomal and extracardiac abnormalities 20%-25% of cardiac malformations are associated with extracardiac malformations. Congenital heart disease occurs in approximately 30% of all chromosomal abnormalities. There is therefore convincing evidence that fetal echocardiography should be routinely included in every scan.
Antenatal detection will affect:
When Should You Screen for Cardiac Anomalies?
The nuchal translucency scan is done at 11- to 14-week. The frequency of cardiac defects increases from an incidence of 5.4 per 1000 births when the nuchal translucency is 2.5 mm to 3.4 mm to 232.6 per 1000 births when the nuchal translucency is above 5.5 mm. Although reported detection rates may be as high as 60%-70% for major congenital heart disease, some anomalies (e.g., critical aortic stenosis) may not be evident at such an early stage.
Because accuracy increases with advancing gestation, the 18- to 22-week scan remains the standard for image quality.
In countries, where ultrasonography is routinely used to screen fetuses for abnormalities, physicians and sonographers need to work in unison to improve detection rates of congenital heart disease. Nuchal translucency screening (at 11-14 wk) and targeted fetal echocardiography in high-risk patients will improve antenatal detection.
Last updated on 25-03-2003
Pediatric Oncall Journal
Syrup formulations of antiretrovirals especially zidovudine and nevirapine are in short supply due to decreased production. How to give prophylaxis to the babies to prevent vertical transmission of HIV_?
Pulverise the adult tablet and give
Do not give prophylaxis to the babies
On humanitarian grounds, the production should be maintained
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