Fetal Echocardiogram

Fetal echocardiogram is an examination of the fetal heart using an ultrasound machine. The development of the heart in a fetus is complete by 11 weeks of pregnancy. However, the heart at this stage is too small to be assessed clearly. One can only see ‘something’ beating. The structures of the fetal heart can be only clearly seen on a per-abdominal ultrasound or echocardiogram at 16-18 weeks. At this stage, the fetal cardiac septum, valves and great vessels can be evaluated by experienced fetal cardiologists or obstetricians. Most of major cardiac abnormalities can be detected by this stage. The examination of the fetal heart takes about 15 to 45 minutes depending on the complexity of the fetal heart problem.

The advantages of in-utero diagnosis of CHD include early intervention for babies with severe cardiac disease can be offered so complication of delayed treatment (e.g. brain injury) can be avoided. If the mother is living far from IJN e.g. East Malaysia, she can be transferred to KL hospital for delivery to avoid delay in treatment and complications of transferring a sick baby. Furthermore, the family can be counseled of the problems and treatment that the baby needs to go through when he/she is delivered. This will help the family to prepare themselves mentally and financially for all the possibilities when the baby is born.

Therefore it is advisable that all pregnant mothers who are at risk of getting a baby with congenital heart disease, have a fetal echocardiogram by an experienced fetal obstetrician or a pediatric cardiologist by 18 weeks of gestation. Mother at risk include those with CHD or with previous baby with CHD, mother with diabetes and SLE, those who are taking anti-epileptic drugs, having Rubella infection, fetus with other structural abnormality e.g. brain or spine abnormality and those fetus with abnormal chromosome. The fetal echo examination is safe as it does not involve any radiation and it is non-invasive.

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IJN EXPERIENCE AND TRACK RECORD

Fetal echo clinic was established in IJN in November 2009. From then until December 2011 we have performed a total of 100 fetal echocardiogram examinations in 78 pregnant mothers. Of these examinations, 66.7% fetuses were found to have congenital heart disease of which 51.3% had complex congenital heart lesions deemed to require surgery or some form of intervention. 6.4% had abnormal cardiac rhythm. Of 78 fetuses, 2 were aborted, 4 died in utero, 4 died immediately after birth, 53 were born alive and the rest were unborn. The cardiac diagnosis was confirmed in 91% of babies who had postnatal echocardiogram with minor discrepancy in 7% of them. Significant discrepancy in diagnosis occurs only in one patient (2%). So far, 10 patients had undergone surgery, 10 are awaiting surgery. 25 did not require treatment. In 8 patients, no surgical treatment could be offered due to severe complexity of the heart lesion.

THE DOCTOR WHO PERFORMS THE PROCEDURE

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