Gebelerin risk gruplarına göre fetüslerindeki yapısal kalp hastalığı sıklığı ve tiplerinin fetal ekokardiyografi tetkiki ile değerlendirilmesi

Yıl 2021, , 905 - 911, 20.11.2021

Hakan Altın

https://doi.org/10.16899/jcm.1014181

Öz

Amaç: Bu çalışmanın amacı düşük riskli ve yüksek riskli gebelerde karşılaşılan konjenital kalp hastalıkları (KKH) sıklığının fetal ekokardiyografi (FE) tetkiki ile araştırılmasıdır
Materyal Metod: Temmuz 2019-Ekim 2021 tarihleri arasında hastanemiz çocuk kardiyoloji polikliniğine başvuran ve FE uygulanan gestasyonel haftası 16 dan büyük 855 gebenin kayıtları geriye dönük olarak incelendi.
Bulgular: Çalışma yaptığımız merkezimize yönlendirilerek FE incelemesi yapılan 855 gebenin 109'unda (%12,7) KKH saptandı. KKH sıklığı risk gruplarına göre verildi. Başvuru nedenlerine göre yüksek riskli grupta yer alan hastalarda DKH nın oranı % 15.2 iken düşük riskli gruptaki hastalarda % 9 olarak tespit edildi (p=0.008). Önemli DKH yüksek riskli grupta % 6.2 iken düşük riskli grupta % 2.7 idi (p=0.016). Fetal ekokardiyografi incelemesinde en sık rastlanan kardiyak anomali ventriküler septal defekt (42 fetusta %38.5) ve ikinci sıklıkta tespit ettiğimiz kardiyak anomali ise atriyoventriküler septal defekt idi (20 fetusta % 18.3).
Sonuç: Çalışmamızda yüksek risk grubundaki gebelerde düşük risk grubundakilere göre daha yüksek oranda KKH bulundu ve özellikle önemli KKH yüksek risk grubundaki gebelerde daha sık saptandı.

Anahtar Kelimeler

fetal ekokardiyografi, konjenital kalp defekti, fetüs

Destekleyen Kurum

yok

Proje Numarası

2021-10/13

Evaluation of the frequency and types of structural heart disease in fetuses of pregnant women according to risk groups by fetal echocardiography

Öz

Aim: The aim of this study is to evaluate the frequency of congenital heart diseases (CHD) encountered in low-risk and high-risk pregnant women by fetal echocardiographic (FE) examination.
Material and Method: The records of 855 pregnant women with a gestational week greater than 16 who applied to the pediatric cardiology outpatient clinic of our hospital between July 2019- October 2021 and underwent FE were analyzed retrospectively.
Results: CHD was detected in 109 (12.7%) of 855 pregnant women who were referred to our center and underwent FE examination. Frequency of CHD was given according to risk groups. The rate of CHD in patients in the high-risk group was 15.2%, while it was 9% in patients in the low-risk group (p=0.008). Significant CHD was 6.2% in the high-risk group versus 2.7% in the low-risk group (p=0.016). The most common structural cardiac anomaly in FE examination was ventricular septal defect (38.5% in 42 fetuses), and the second most common cardiac anomaly was atriyoventricular septal defect (18.3% in 20 fetuses).
Conclusion: In our study, it was found a higher rate of CHD in pregnant women in the high-risk group than in the low-risk group and especially significant CHD was detected more common in pregnant women in the high-risk group.

Anahtar Kelimeler

fetal echocardiography, congenital heart defects, fetuses

Proje Numarası

2021-10/13

Kaynakça

• Referans1 Donofrio MT, Moon-Grady AJ, Hornberger LK et al. American Heart Association Adults With Congenital Heart Disease Joint Committee of the Council on Cardiovascular Disease in the Young and Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Council on Cardiovascular and Stroke Nursing. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation 2014;129(21):2183-242.
• Referans2 Wren C, Richmond S, Donaldson L. Temporal variability in birth prevalence of cardiovascular malformations. Heart 2000;83:414-9.
• Referans3 Tegnander E, Williams W, Johansen OJ, Blaas HG, Eik-Nes SH. Prenatal detection of heart defects in a non-selected population of 30,149 fetuses: detection rates and outcome. Ultrasound Obstet Gynecol 2006;27:252-65.
• Referans4 Hunter S, Heads A, Wyllie J, Robson S. Prenatal diagnosis of congenital heart disease in the northern region of England: benefits of a training program for obstetric ultrasonographers. Heart 2000;84: 294-8.
• Referans5 Ozkutlu S, Ayabakan C, Karagöz T et al. Prenatal echocardiographic diagnosis of congenital heart disease: comparison of past and current results. Turk J Pediatr 2005;47(3):232-8.
• Referans6 Todros T, Faggiano F, Chiappa E, Gaglioti P, Mitola B, Sciarrone A. Accuracy of routine ultrasonography in screening heart disease prenatally. Gruppo Piemontese for Prenatal Screening of Congenital Heart Disease. Prenat Diagn 1997;17(10):901-6.
• Referans7 Paladini D, Russo MG, Teodoro A et al. Prenatal diagnosis of congenital heart disease in the Naples area during the years 1994-1999 - the experience of a joint fetalpediatric cardiology unit. Prenat Diagn 2002;22: 545-52.
• Referans8 Perri T, Cohen-Sacher B, Hod M, Berant M, Meizner I, Bar J. Risk factors for cardiac malformations detected by fetal echocardiography in tertiary center. J Matern Fetal Neonatal Med 2005;17: 123-8.
• Referans9 Chu C, Yan Y, Ren Y, Li X, Gui Y. Prenatal diagnosis of congenital heart diseases by fetal echocardiography in second trimester: a Chinese multicenter study. Acta Obstet Gynecol Scand 2017;96(4):454-63.
• Referans10 Hallıoğlu O, Karpuz D, Giray D, Demetgül H, Öztaş A. Doğumsal Kalp Hastalıkları Sıklığının Risk Gruplarına Göre Dağılımı: Fetal Ekokardiyografik Tarama. Jinekoloji - Obstetrik ve Neonatoloji Tıp Dergisi 2018;15(1):1-4.
• Referans11 Ozbarlas N, Erdem S, Küçükosmanoğlu O et al. Prevalence and distribution of structural heart diseases in high and low risk pregnancies. Anadolu Kardiyol Derg 2011;11(2):125-30.
• Referans12 Ozkutlu S, Bostan OM, Deren O et al. Prenatal echocardiographic diagnosis of cardiac right/left axis and malpositions according to standardized Cordes technique. Anadolu Kardiyol Derg 2011;11(2):131-6.
• Referans13 Alp H, Karaarslan S, Baysal T, Karataylı R, Varan B. Riskli Gebeliklerde Fetal Ekokardiyografide Tespit Edilen Yapısal Kalp Hastalıklarının Dağılımı. Selçuk Tıp Derg 2013;29(3):113-6.
• Referans14 Güven MA, Ceylaner S, Aydemir N. Fetal Ekokardiyografi: Prenatal Ultrasonografik Özellikler ve Klinik Sonuçlar. Perinatoloji Dergisi 2004;12(4):184-90.
• Referans15 Chitra N, Vijayalakshmi IB. Fetal echocardiography for early detection of congenital heart diseases. J Echocardiogr 2017;15(1):13-7.
• Referans16 Rakha S, El Marsafawy H. Sensitivity, specificity, and accuracy of fetal echocardiography for high-risk pregnancies in a tertiary center in Egypt. Arch Pediatr 2019;26(6):337-41.
• Referans17 Pierpont ME, Basson CT, Benson DW Jr et al. Genetic basis for congenital heart defects: current knowledge: a scientific state- ment from the American Heart Association Congenital Cardiac Defects Committee, Council on Cardiovascular Disease in the Young. Circulation 2007;115:3015–38.
• Referans18 Greenwood RD, Rosenthal A, Parisi L, Fyler DC, Nadas AS. Extracardiac abnormalities in infants with congenital heart disease. Pediatrics 1975;55:485-92.
• Referans19 Miller A, Riehle-Colarusso T, Alverson CJ, Frias JL, Correa A. Congenital heart defects and major structural noncardiac anomalies, Atlanta, Georgia, 1968 to 2005. J Pediatr 2011;159:70-8.e2.
• Referans20 Simpson LL. Indications for fetal echocardiography from a tertiarycare obstetric sonography practice. J Clin Ultrasound 2004;32:123-8.
• Referans21 Cooper MJ, Enderlein MA, Dyson DC, Roge CL, Tarnoff H. Fetal echocardiography: retrospective review of clinical experience and an evaluation of indications. Obstet Gynecol 1995; 86: 577-82.
• Referans22 Burn J, Brennan P, Little J et al. Recurrence risks in offspring of adults with major heart defects: results from first cohort of British collaborative study. Lancet 1998;351:311–6.
• Referans23 Oyen N, Poulsen G, Boyd HA, Wohlfahrt J, Jensen PK, Melbye M. Recurrence of congenital heart defects in families. Circulation 2009;120:295–301.
• Referans24 Best KE, Rankin J. Is advanced maternal age a risk factor for congenital heart disease? Birth Defects Res A Clin Mol Teratol 2016;106(6):461-7.
• Referans25 Pierpont ME, Basson CT, Benson DW Jr et al. American Heart Association Congenital Cardiac Defects Committee, Council on Cardiovascular Disease in the Young. Genetic basis for congenital heart defects: current knowledge: a scientific statement from the American Heart Association Congenital Cardiac Defects Committee, Council on Cardiovascular Disease in the Young: endorsed by the American Academy of Pediatrics. Circulation 2007;115(23):3015-38.
• Referans26 Barker PCA, Lewin MB, Donofrio MT et al. Specific Considerations for Pediatric, Fetal, and Congenital Heart Disease Patients and Echocardiography Service Providers during the 2019 Novel Coronavirus Outbreak: Council on Pediatric and Congenital Heart Disease Supplement to the Statement of the American Society of Echocardiography: Endorsed by the Society of Pediatric Echocardiography and the Fetal Heart Society. J Am Soc Echocardiogr 2020;33(6):658-65.
• Referans27 Strasburger JF, Huhta JC, Carpenter RJ Jr, Garson A Jr, McNamara DG. Doppler echocardiography in the diagnosis and management of persistent fetal arrhythmias. J Am Coll Cardiol 1986;7:1386–91.
• Referans28 Weber R, Stambach D, Jaeggi E. Diagnosis and management of common fetal arrhythmias. J Saudi Heart Assoc 2011;23(2):61-6.
• Referans29 Silverman NH, Enderlein MA, Stanger P, Teitel DF, Heymann MA, Golbus MS. Recognition of fetal arrhythmias by echocardiography. J Clin Ultrasound 1985;13(4):255-63.
• Referans30 Yuan SM. Fetal arrhythmias: Surveillance and management. Hellenic J Cardiol 2019;60(2):72-81.