Fetal ekokardiyografide saptanan fetal kardiyak ekojenik odakların konjenital kalp hastalıkları ile ilişkisi: Kesitsel bir çalışma.
Öz
Öz
Amaç: Çalışmamızın amacı intrakardiyak ekojenik odak prevalansını belirlemek ve riskli gebeliklerde konjenital kalp hastalıklarıyla olası ilişkisini araştırmaktır.
Gereç ve Yöntemler: Çalışmamıza 17-36. gebelik haftasında olan toplam 380 gebe dahil edildi. Hastalar herhangi bir ilaç kullanımı, kromozomal veya fetal anomalilerin varlığı, önceki gebeliklerin sayısı ve özellikleri, ailede konjenital veya edinilmiş kalp hastalıkları ve aile öyküsünün varlığı gibi çeşitli sevk nedenlerine göre düşük riskli ve yüksek riskli gruplar olarak sınıflandırıldı.
Bulgular: Seçici kriterlere göre 134 (%35,26) gebe düşük riskli grup olarak sınıflandırılırken, 246 (%64,74) gebe yüksek riskli grup olarak sınıflandırıldı. Yüksek risk grubunda en sık sevk nedeni maternal diyabet (%13,16) idi. Ancak düşük riskli gebeliklerde, ultrasonografi ile fetal kalbin iyi görüntülenmemesi sevk için en önemli nedendi (%21,05). Toplam 77 (%20,26) gebede intrakardiyak ekojenik odaklar tespit edildi, bunlardan 68 (%50,75) tanesi düşük risk grubunda ve 9 (%3,66) tanesi de yüksek risk grubundaydı. Düşük riskli gebeliklerde 59 (%44,03) fetüste ve yüksek riskli gebeliklerde 4 (%1,63) fetüste sol ventrikülde ekojenik odaklar tespit edildi (p=0,001). Ek olarak, konjenital kalp hastalığı tespit edilen düşük ve yüksek risk grubundaki birer fetüste sol ventrikülde yerleşimli ekojenik odaklar tespit edildi.
Sonuç: Sonuç olarak, düşük riskli gebeliklerde intrakardiyak ekojenik odakların prevalansını %50,75 olarak bulduk ki bu yüksek riskli gebeliklere göre daha yüksekti. Bu durum; etnik kökene, üçüncü basamak hastane sevklerine, nispeten düşük hasta sayısına ve diğer ilişkili faktörlere bağlanabilir. Ek olarak, çalışmamızda, hem düşük hem de yüksek riskli gebeliklerde konjenital kalp hastalıkları ile intrakardiyak ekojenik odaklar arasında bir ilişki tespit edilmedi.
Anahtar Kelimeler
Riskli gebelikler intrakardiyak ekojenik odak konjenital kalp hastalığı
Kaynakça
- 1. Schechter AG, Fakhry J, Shapiro LR, Gewitz MH. In utero thickening of the chordae tendinae. A cause of intracardiac echogenic foci. J Ultrasound Med 1987;6:691-5.
- 2. Petrikovsky B, Challenger M, Gross B. Unusual appearances of echogenic foci within the fetal heart: are they benign? Ultrasound Obstetric Gynecol 1996;8(4):229-31.
- 3. Levy DW, Mintz MC. The left ventricular echogenic focus: a normal finding. AJR Am J Roentgenol 1988;150:85-6.
- 4. Brown DL, Roberts DJ, Miller WA. Left ventricular echogenic focus in the fetal heart: pathologic correlation. J Ultrasound Med 1994;13:613-6.
- 5. Anderson N, Jyoti R. Relationship of isolated fetal intracardiac echogenic focus to trisomy 21 at the mid-trimester sonogram in women younger than 35 years. Ultrasound Obstet Gynecol 2003;21:354-8.
- 6. Bradley KE, Santulli TS, Gregory KD, Herbert W, Carlson DE, Platt LD. An isolated intracardiac echogenic focus as a marker for aneuploidy. Am J Obstet Gynecol 2005;192:2021-6.
- 7. Rodriguez R, Herrero B, Bartha JL. The continuing enigma of the fetal echogenic intracardiac focus in prenatal ultrasound. Curr Opin Obstet Gynecol 2013;25(2):145-51.
- 8. Achiron R, Lipitz S, Gabbay U, Yagel S. Prenatal ultrasonographic diagnosis of fetal heart echogenic foci: no correlation with Down syndrome. Obstet Gynecol 1997;89(6):945-8.
- 9. Bromley B, Lieberman E, Laboda L, Benacerraf BR. Echogenic intracardiac focus: a sonographic sign for fetal Down syndrome. Obstet Gynecol 1995;86(6):998-1001.
- 10. Bromley B, Lieberman E, Shipp TD, Richardson M, Benacerraf BR. Significance of an echogenic intracardiac focus in fetuses at high and low risk for aneuploidy. J Ultrasound Med 1998;17(2):127-31.
- 11. How HY, Villafane J, Parihus RR, et al. Small hyperechoic foci of the fetal cardiac ventricle: a benign sonographic finding? Ultrasound Obstet Gynecol 1994;4:205.
- 12. Wax JR, Mather J, Steinfeld JD, et al. Fetal Intracardiac Echogenic Foci: current understanding and clinical significance. Obstet Gynecol Surv 2000;55:303.
- 13. Simpson JM, Cook A, Sharland G. The significance of echogenic foci in the fetal heart: a prospective study of 228 cases. Ultrasound Obstet Gynecol 1996;8:225–8.
- 14. Vibhakar NI, Budorick NE, Scioscia AL, Harby LD, Mullen ML, Sklansky MS. Prevalence of aneuploidy with a cardiac intraventricular echogenic focus in an at-risk patient population. J Ultrasound Med 1999;18:265–8.
- 15. Goncalves TR, Zamith MM, Murta CG, Bussamra LC, Torloni MR, Moron AF. Chromosomal and cardiac anomalies in fetuses with intracardiac echogenic foci. Int J Gynaecol Obstet 2006;95:132-7.
- 16. Wax JR, Philput C. Fetal intracardiac echogenic foci: does it matter which ventricle? J Ultrasound Med 1998;17:141-4.
- 17. Bronshtein M, Jakobi P, Ofir C. Multiple fetal intracardiac echogenic foci: not always a benign sonographic finding. Prenat Diagn 1996;16:131-5.
- 18. Donofrio MT, Moon-Grady AJ, Hornberger LK et al. American Heart Association Adults With Congenital Heart Disease Joint Committee of the Council on Cardiovascular Disease in the Young and Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Council on Cardiovascular and Stroke Nursing. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation 2014;129(21):2183-242.
- 19. Wright L, Stauffer N, Samai C, Oster M. Who should be referred? An evaluation of referral indications for fetal echocardiography in the detection of structural congenital heart disease. Pediatr Cardiol 2014;35:928-33.
- 20. Özkutlu S, Ayabakan C, Karagöz T, et al. Prenatal echocardiographic diagnosis of congenital heart disease: comparison of past and current results. Turk J Pediatr 2005;47:232-8.
- 21. Bethune M. Management options for echogenic intracardiac focus and choroid plexus cysts: a review including Australian Association of Obstetrical and Gynaecological Ultrasonologists consensus statement. Australas Radiol 2007;51:324e9.
- 22. Shipp TD, Bromley B, Lieberman E, et al. The frequency of the detection of fetal echogenic intracardiac foci concerning maternal race. Ultrasound Obstet Gynecol 2000;15:460.
- 23. Merati R. Lovotti M, Norchi S et al. Prevalence of fetal left ventricular hyperechogenic foci in a low-risk population. Br J Obstet Gynaecol 1996;103:1102-4.
- 24. Guo Y, He Y, Gu X et al. Echogenic intracardiac foci and fetal cardiac anomalies: A review of cases from a tertiary care center in China. J Clin Ultrasound. 2017;1–5.
- 25. Carrico A, Matias A, Areias JC (2004) How important is a cardiac echogenic focus in a routine fetal examination? Rev Port Cardiol 23:459–61
- 26. Barsoom MJ, Feldman DM, Borgida AF, Esters D, Diana D, Egan JF. Is an isolated fetal cardiac echogenic focus an indication for fetal echocardiography? J Ultrasound Med 2001;20:1043-6.
- 27. Shakoor S, Ismail H, Munim S. Intracardiac echogenic focus and fetal outcome - review of cases from a tertiary care center in Karachi, Pakistan. J Matern Fetal Neonatal Med 2013;26:2-4.
- 28. Goncalves TR, Zamith MM, Murta CG, Bussamra LC, Torloni MR, Moron AF. Chromosomal and cardiac anomalies in fetuses with intracardiac echogenic foci. Int J Gynaecol Obstet 2006;95:132-7.
- 29. Chiu G, Zhao A, Zhang B, Zhang T. Intracardiac echogenic focus and its location: association with congenital heart defects. J Matern Fetal Neonatal Med 2019;32(18):3074-8.
- 30. Dildy GA, Judd VE, Clark SL. Prospective evaluation of the antenatal incidence and postnatal significance of the fetal echogenic cardiac focus: A case-control study. Am J Obstet Gynecol 1996;175:1008–12.
- 31. Wolman I, Jaffa A, Geva E, Diamant S, Strauss S, Lessing JB, Yaron Y. Intracardiac echogenic focus: no apparent association with structural cardiac abnormality. Fetal Diagn Ther 2000;15:216–8.
The relationship between fetal cardiac echogenic foci detected in fetal echocardiography and congenital heart diseases: A cross-sectional study.
Öz
Abstract
Aim: The aim of our study is to determine the prevalence of intracardiac echogenic focus and to investigate the possible association of congenital heart diseases in risky pregnancies.
Materials and Methods: A total of 380 pregnant women who were in the 17th to 36th week of gestation were included in our study. The patients were classified as low risk and high risk groups according to various referral reasons such as any drug usage, presence of chromosomal or fetal anomalies, number and characteristics of previous pregnancies, congenital or acquired heart diseases in the family and presence of family history.
Results: Based on the selective criteria 134 (35.26%) pregnant women were classified as the low-risk group while 246 (64.74%) pregnant were classified as the high-risk group. Maternal diabetes (13.16%) was the most common reason for referral in the high-risk group. However, in the low-risk pregnancies, lack of good image of the fetal heart by ultrasonography was the major reason for referral (21.05%). Intracardiac echogenic foci were detected in total of 77 (20.26%) cases, which of 68 (50.75%) cases were in the low-risk group and 9 (3.66%) cases were in the high-risk group. Left ventricular echogenic foci were detected in 59 (44.03%) fetuses in low-risk pregnancies and 4 (1.63%) fetuses in high-risk pregnancies (p=0.001). Additionally, only one fetus in low-risk pregnancy and one fetus in high-risk pregnancy had echogenic foci in one of the ventricles with congenital heart diseases.
Conclusion: In conclusion, we found the prevalence of intracardiac echogenic foci in low-risk pregnancies as 50.75% which was higher than in high-risk pregnancies. This can be attributed to ethnicity, tertiary hospital referrals, relatively low number of patients and other associated factors. Additionally, in our study, no correlation was found between congenital heart diseases and intracardiac echogenic foci in both low- and high-risk pregnancies.
Anahtar Kelimeler
Risky pregnancies intracardiac echogenic focus congenital heart diseases
Kaynakça
- 1. Schechter AG, Fakhry J, Shapiro LR, Gewitz MH. In utero thickening of the chordae tendinae. A cause of intracardiac echogenic foci. J Ultrasound Med 1987;6:691-5.
- 2. Petrikovsky B, Challenger M, Gross B. Unusual appearances of echogenic foci within the fetal heart: are they benign? Ultrasound Obstetric Gynecol 1996;8(4):229-31.
- 3. Levy DW, Mintz MC. The left ventricular echogenic focus: a normal finding. AJR Am J Roentgenol 1988;150:85-6.
- 4. Brown DL, Roberts DJ, Miller WA. Left ventricular echogenic focus in the fetal heart: pathologic correlation. J Ultrasound Med 1994;13:613-6.
- 5. Anderson N, Jyoti R. Relationship of isolated fetal intracardiac echogenic focus to trisomy 21 at the mid-trimester sonogram in women younger than 35 years. Ultrasound Obstet Gynecol 2003;21:354-8.
- 6. Bradley KE, Santulli TS, Gregory KD, Herbert W, Carlson DE, Platt LD. An isolated intracardiac echogenic focus as a marker for aneuploidy. Am J Obstet Gynecol 2005;192:2021-6.
- 7. Rodriguez R, Herrero B, Bartha JL. The continuing enigma of the fetal echogenic intracardiac focus in prenatal ultrasound. Curr Opin Obstet Gynecol 2013;25(2):145-51.
- 8. Achiron R, Lipitz S, Gabbay U, Yagel S. Prenatal ultrasonographic diagnosis of fetal heart echogenic foci: no correlation with Down syndrome. Obstet Gynecol 1997;89(6):945-8.
- 9. Bromley B, Lieberman E, Laboda L, Benacerraf BR. Echogenic intracardiac focus: a sonographic sign for fetal Down syndrome. Obstet Gynecol 1995;86(6):998-1001.
- 10. Bromley B, Lieberman E, Shipp TD, Richardson M, Benacerraf BR. Significance of an echogenic intracardiac focus in fetuses at high and low risk for aneuploidy. J Ultrasound Med 1998;17(2):127-31.
- 11. How HY, Villafane J, Parihus RR, et al. Small hyperechoic foci of the fetal cardiac ventricle: a benign sonographic finding? Ultrasound Obstet Gynecol 1994;4:205.
- 12. Wax JR, Mather J, Steinfeld JD, et al. Fetal Intracardiac Echogenic Foci: current understanding and clinical significance. Obstet Gynecol Surv 2000;55:303.
- 13. Simpson JM, Cook A, Sharland G. The significance of echogenic foci in the fetal heart: a prospective study of 228 cases. Ultrasound Obstet Gynecol 1996;8:225–8.
- 14. Vibhakar NI, Budorick NE, Scioscia AL, Harby LD, Mullen ML, Sklansky MS. Prevalence of aneuploidy with a cardiac intraventricular echogenic focus in an at-risk patient population. J Ultrasound Med 1999;18:265–8.
- 15. Goncalves TR, Zamith MM, Murta CG, Bussamra LC, Torloni MR, Moron AF. Chromosomal and cardiac anomalies in fetuses with intracardiac echogenic foci. Int J Gynaecol Obstet 2006;95:132-7.
- 16. Wax JR, Philput C. Fetal intracardiac echogenic foci: does it matter which ventricle? J Ultrasound Med 1998;17:141-4.
- 17. Bronshtein M, Jakobi P, Ofir C. Multiple fetal intracardiac echogenic foci: not always a benign sonographic finding. Prenat Diagn 1996;16:131-5.
- 18. Donofrio MT, Moon-Grady AJ, Hornberger LK et al. American Heart Association Adults With Congenital Heart Disease Joint Committee of the Council on Cardiovascular Disease in the Young and Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Council on Cardiovascular and Stroke Nursing. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation 2014;129(21):2183-242.
- 19. Wright L, Stauffer N, Samai C, Oster M. Who should be referred? An evaluation of referral indications for fetal echocardiography in the detection of structural congenital heart disease. Pediatr Cardiol 2014;35:928-33.
- 20. Özkutlu S, Ayabakan C, Karagöz T, et al. Prenatal echocardiographic diagnosis of congenital heart disease: comparison of past and current results. Turk J Pediatr 2005;47:232-8.
- 21. Bethune M. Management options for echogenic intracardiac focus and choroid plexus cysts: a review including Australian Association of Obstetrical and Gynaecological Ultrasonologists consensus statement. Australas Radiol 2007;51:324e9.
- 22. Shipp TD, Bromley B, Lieberman E, et al. The frequency of the detection of fetal echogenic intracardiac foci concerning maternal race. Ultrasound Obstet Gynecol 2000;15:460.
- 23. Merati R. Lovotti M, Norchi S et al. Prevalence of fetal left ventricular hyperechogenic foci in a low-risk population. Br J Obstet Gynaecol 1996;103:1102-4.
- 24. Guo Y, He Y, Gu X et al. Echogenic intracardiac foci and fetal cardiac anomalies: A review of cases from a tertiary care center in China. J Clin Ultrasound. 2017;1–5.
- 25. Carrico A, Matias A, Areias JC (2004) How important is a cardiac echogenic focus in a routine fetal examination? Rev Port Cardiol 23:459–61
- 26. Barsoom MJ, Feldman DM, Borgida AF, Esters D, Diana D, Egan JF. Is an isolated fetal cardiac echogenic focus an indication for fetal echocardiography? J Ultrasound Med 2001;20:1043-6.
- 27. Shakoor S, Ismail H, Munim S. Intracardiac echogenic focus and fetal outcome - review of cases from a tertiary care center in Karachi, Pakistan. J Matern Fetal Neonatal Med 2013;26:2-4.
- 28. Goncalves TR, Zamith MM, Murta CG, Bussamra LC, Torloni MR, Moron AF. Chromosomal and cardiac anomalies in fetuses with intracardiac echogenic foci. Int J Gynaecol Obstet 2006;95:132-7.
- 29. Chiu G, Zhao A, Zhang B, Zhang T. Intracardiac echogenic focus and its location: association with congenital heart defects. J Matern Fetal Neonatal Med 2019;32(18):3074-8.
- 30. Dildy GA, Judd VE, Clark SL. Prospective evaluation of the antenatal incidence and postnatal significance of the fetal echogenic cardiac focus: A case-control study. Am J Obstet Gynecol 1996;175:1008–12.
- 31. Wolman I, Jaffa A, Geva E, Diamant S, Strauss S, Lessing JB, Yaron Y. Intracardiac echogenic focus: no apparent association with structural cardiac abnormality. Fetal Diagn Ther 2000;15:216–8.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri (Diğer) |
| Bölüm | Original Article |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Nisan 2025 |
| Gönderilme Tarihi | 25 Kasım 2024 |
| Kabul Tarihi | 6 Ocak 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 35 Sayı: 2 |
Genel Tıp Dergisi Creative Commons Atıf-GayriTicari 4.0 Uluslararası Lisansı (CC BY NC) ile lisanslanmıştır.