Value of fetal echocardiography on prenatal diagnosis of ventricular septal defect

Objective To investigate the diagnostic value and limitations of prenatal echocardiography on fetal ventricular septal defect (VSD).Methods Fetal echocardiography was performed on 4392 pregnant women (including one twin pregnancy) during their 20 to 24 weeks of gestation who accepted routine prenatal care in Obstetrics and Gynecology Hospital of Fudan University from January 1,2009 to October 31,2010.Neonatal echocardiography was performed within 48 hours after birth; and fetal autopsy was done for mid-trimester terminated cases to confirm the diagnosis.Detection rate and missed diagnosis rate of prenatal echocardiography on VSD were calculated.Results (1) Complicated VSD (associated with other cardiac defects):Twenty-three cases of complicated VSD were detected prenatally,among which 22 cases were terminated at midtrimester and another one was suspected as VSD complicated with partial endocardial cushion defect,while it was finally diagnosed as normal after birth.(2)Isolated VSD:Sixteen prenatally suspected VSD were confirmed after birth as 15 normal cases and one case of isolated VSD.(3)Detection rate of prenatal echocardiography:Among the rest 4354 cases without VSD in prenatal echocardiography,there were 54 cases of isolated VSD by neonatal echocardiography.A total of 77 cases of VSD were confirmed by prenatal and postnatal two-dimension echocardiography or autopsy.The incidence of VSDwas 1.8％ (77/4393),isolated VSD was 1.3％ (55/4393),and complicated VSD was 0.5％(22/4393).Prenatal detection rate of complicated VSD was 100.0％ (22/22) ; missed diagnosis rate and misdiagnosis rate was 0.0％ (0/22) and 0.2‰ (1/4371) respectively.Prenatal detection rate of isolated VSD was 1.8％ (1/55),missed diagnosis rate and misdiagnosis rate was 98.2％ (54/55) and 3.5‰ (15/4338) respectively.Conclusions Prenatal detection rate of VSD by echocardiography on fetus with complicated VSD is high,while prenatal detection rate of fetal isolated VSD is very low. Key words: Heart septal defects, ventricular;  Ultrasonography, prenatal;  Echocardiography,doppler, color