Journal of Ultrasound in Medicine, Vol 20, Issue 10 1043-1046, Copyright © 2001 by American Institute of Ultrasound in Medicine
Is an isolated fetal cardiac echogenic focus an indication for fetal echocardiography?
M. J. Barsoom, D. M. Feldman, A. F. Borgida, D. Esters, D. Diana and J. F. Egan
Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington 06030, USA.
OBJECTIVE: To determine whether the presence of an isolated fetal cardiac
echogenic focus should be an indication for fetal echocardiography.
METHODS: We reviewed our fetal echocardiography and obstetrics databases
from January 1992 through July 1999. The study groups were formulated from
patients referred for fetal echocardiography. Patients referred for
echocardiography because of a single isolated fetal cardiac echogenic focus
were compared with patients referred for other indications. The
sensitivity, specificity, and positive and negative predictive values were
calculated for an isolated echogenic focus as a marker for structural
cardiac abnormalities as detected by fetal echocardiography. RESULTS: Of
10,406 fetuses seen for ultrasonography, 1908 had fetal echocardiography.
Cardiac abnormalities were identified in 3.4% (65 of 1908) of the fetuses
that had echocardiography. The prevalence of an isolated echogenic focus
was 2.2% (230 of 10,406) and was the indication in 12.1% (230 of 1908) of
our echocardiograms. Only 1 of the 230 fetuses with an isolated echogenic
focus had a structural cardiac defect (membranous ventricular septal
defect). An isolated echogenic focus as a marker for congenital cardiac
defects resulted in sensitivity and specificity of 1.5% and 87.6%,
respectively. The positive and negative predictive values were 0.4% and
96.2%, respectively The relative risk for an echogenic focus in predicting
congenital cardiac defects was 0.11 (95% confidence interval, 0.02-0.82).
CONDUSIONS: An isolated fetal cardiac echogenic focus is not an efficacious
marker for congenital cardiac defects. It should not be the sole indication
for fetal echocardiography.
