SONOGRAPHIC DIAGNOSIS OF CONGENITAL HEART-DISEASE - COMPARISON BETWEEN THE 4-CHAMBER VIEW AND MULTIPLE CARDIAC VIEWS

Objective: To report our experience in the detection of congenital hea rt disease using both the four-chamber view of the heart as part of th e standard obstetric ultrasound examination and multiple cardiac views as part of the detailed targeted examination. Methods: All admissions to Children's Memorial Hospital of Northwestern University Medical Ce nter with the diagnosis of congenital heart disease between June 1988 and April 1992 were identified (N = 1947). These admissions were match ed to deliveries (N = 19,321) that occurred at Prentice Women's Hospit al during the same period; of these, 10,004 had at least one obstetric ultrasound examination. All fetuses were scanned either with the stan dard obstetric ultrasound type of examination, featuring only the four -chamber view of the heart, or by the detailed targeted imaging type o f study, featuring multiple cardiac views. The type of examination per formed was based on the specific request of the attending obstetrician or gynecologist. Results: Thirty-three neonates who had at least one obstetric ultrasound examination were treated for congenital heart dis ease. An additional five pregnancies were terminated secondary to seri ous fetal heart defects. When only the four-chamber view was visualize d, 11 of 33 fetuses (33.3%) with confirmed congenital heart disease we re detected. Conclusions: Assessment of the outflow tracts is crucial for detection of many forms of congenital heart disease. However, befo re this is accepted as the standard of care, both the obstetric and ra diologic communities should develop their skills in cardiac imaging. O nly then can this sophisticated type of cardiac examination be offered to pregnant women.