FETAL CARDIOMEGALY - ECHOCARDIOGRAPHIC FINDINGS AND OUTCOME IN 19 CASES

The echocardiographic findings and clinical courses in 19 fetuses with marked cardiomegaly [heart length, width, area, cardiothoracic ratio, heart/thoracic area (CTA) ratio >2 SD] were reviewed. An abnormal hea rt was the reason for referral in 16 cases of 19 (84.2%). The mean ges tational age was 31.5 weeks at detection. Intracardiac hemodynamics we re studied using pulsed, color, and M-Mode color Doppler. Despite the heterogeneous etiology of marked cardiomegaly (5 Ebstein's anomalies, 5 tricuspid valve dysplasias, 3 dilatative cardiomyopathies and 6 misc ellaneous) a holosystolic tricuspid regurgitation with right atrial en largement was found in 17 of the 19 cases (89.4%) as a common pathogen etic feature. A hydrops was found in 10 cases (52.6%). Besides 1 elect ive legal abortion, a high mortality rate of 83.3% was observed in the group followed up (6 intrauterine and 9 neonatal deaths). Among the c ardiac measurements the CTA ratio seemed to correlate with fetal outco me, since all three survivors had the lowest values and all fetuses wi th CTA ratio >0.6 showed a lung hypoplasia as a sequel of compression by cardiac enlargement. The presence or the development of hydrops, an obstruction of the right ventricular outflow tract, and the lung hypo plasia could be considered as signs of poor prognosis. A reliable diff erentiation between a patent pulmonary valve, pulmonary stenosis and p ulmonary atresia in severe tricuspid regurgitation using modern Dopple r means is difficult as seen in our studied group and in the literatur e. A cardiomegaly could be detected by nonexperienced examiners, but e ven if its presentation in fetal life could be considered as one of th e main predictors of poor outcome, such cases have to be referred to c entres experienced in fetal echocardiography.