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Childhood Cardiac Function After Prenatal Diagnosis of Intracardiac Echogenic Foci

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.R.W., M.C., R.C., M.G.P., J.B., A.C.), and Division of Pediatric Cardiology, Barbara Bush Children’s Hospital, Portland, Maine USA (J.D.).

Address correspondence and reprint requests to Joseph R. Wax, MD, MMC Ob/Gyn Associates, 887 Congress St, Suite 200, Portland, ME 04102 USA. E-mail: waxj{at}mmc.org.

Objective. To determine whether prenatally diagnosed intracardiac echogenic foci are associated with childhood cardiac dysfunction and persistence. Methods. Children in whom intracardiac echogenic foci were shown on prenatal sonography at 1 perinatal center underwent echocardiography at ages 2 to 7 years. A single pediatric cardiologist, blinded to the prenatal sonographic intracardiac echogenic focus locations, assessed cardiac function by measuring the left ventricular shortening fraction and myocardial performance index. The presence of tricuspid and mitral valve regurgitation was also sought. The secondary outcome was intracardiac echogenic focus persistence. Results. Twenty-five children, 14 (56%) male and 11 (44%) female, were examined at a mean age ± SD of 3.0 ± 1.0 years. Prenatally, 18 children (72%) had left ventricular intracardiac echogenic foci, and 7 (28%) had right ventricular intracardiac echogenic foci. The left ventricular shortening fraction was normal in all children. The overall mean left ventricular myocardial performance index (reference value, 0.36 ± 0.06), was normal for both children with left ventricular intracardiac echogenic foci (0.36 ± 0.06) and those with right ventricular intracardiac echogenic foci (0.36 ± 0.04). Two children with left ventricular intracardiac echogenic foci had an isolated left ventricular myocardial performance index of greater than 2.5 SD above the mean. Trace tricuspid valve regurgitation and mitral valve regurgitation were noted in 13 (52%) and 2 (8%) of the children, respectively, similar to the general population. Left ventricular intracardiac echogenic foci persisted in 16 children (89%), whereas right ventricular intracardiac echogenic foci persisted in 2 (29%) (P = .007). Conclusions. Prenatally diagnosed intracardiac echogenic foci are often persistent but not associated with childhood myocardial dysfunction.

Key Words: echocardiography • intracardiac echogenic focus • prenatal diagnosis • sonography

Abbreviations: ICEF, intracardiac echogenic foci • LV, left ventricular • LVSF, left ventricular shortening fraction • MPI, myocardial performance index • MVR, mitral valve regurgitation • RV, right ventricular • TVR, tricuspid valve regurgitation

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