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Prenatal Detection of Congenital Heart Disease in Southern Nevada

The Need for Universal Fetal Cardiac Evaluation

Children’s Heart Center, Las Vegas, Nevada USA (R.J.A., W.N.E., C.F.L., R.R., K.T.K., J.C.C., H.R.); Departments of Pediatrics (R.J.A., W.N.E., C.F.L., R.R., K.T.K., H.R.) and Obstetrics and Gynecology (J.A., D.R., A.J.S.), University of Nevada, School of Medicine (J.C.C.), Las Vegas, Nevada USA; Desert Perinatal Associates, Las Vegas, Nevada USA (J.A.); Center for Maternal-Fetal Medicine, Las Vegas, Nevada USA (B.K.I.); Department of Obstetrics and Gynecology, University Medical Center, Las Vegas, Nevada USA (D.R.); and Alan J. Sacks Maternal-Fetal Medicine, Las Vegas, Nevada USA (A.J.S.).

Address correspondence to Ruben J. Acherman, MD, Fetal Cardiology Program, Children’s Heart Center, 3006 S Maryland Pkwy, Suite 690, Las Vegas, NV 89109 USA. E-mail: iacherman{at}aol.com

Objective. Congenital cardiac malformations are common developmental anomalies. In the United States, congenital heart disease is the number one cause of infant mortality from congenital malformations. Prenatal diagnosis of congenital heart defects aids treatment coordination. Our aim was to evaluate prenatal detection of serious congenital heart malformations in Clark County, Nevada. Methods. We electronically searched our research department–maintained computer database for patients with serious congenital heart disease born in Clark County between May 2003 and April 2006. We excluded patients that did not have at least 1 local prenatal ultrasound examination. All pre-natal ultrasound studies were performed in obstetric offices, radiology imaging centers, or maternal-fetal medicine specialty practices. Fetal echocardiography was performed in maternal-fetal medicine specialists’ offices under the supervision of a fetal cardiologist. Pediatric cardiologists performed all postnatal echocardiographic examinations. Results. During the study period, we diagnosed serious congenital heart malformations in 161 patients among a total estimated 77,000 births (2/1000). Of the 161 patients, 58 (36%) had a prenatal diagnosis, and 103 (64%) had an exclusively postnatal diagnosis. Conclusions. Standard prenatal ultrasound fails to show congenital heart disease in most fetuses.

Key Words: congenital heart disease • fetal echocardiography • prenatal diagnosis • prenatal ultrasound

Abbreviations: AV, atrioventricular

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