Key result
Fetal isolated right dominant heart diagnosed in the second trimester was associated with a lower rate of normal postnatal cardiac anatomy compared to third-trimester diagnosis (26% vs 86%).
Why the study?
Does the finding of isolated right dominant heart on fetal echocardiography predict postnatal cardiac anomalies?
Cohort (n=44)
No
Does the finding of isolated right dominant heart on fetal echocardiography predict postnatal cardiac anomalies?
Isolated right dominant heart in fetuses, particularly when diagnosed in the second trimester, is a significant risk factor for postnatal coarctation of the aorta and warrants neonatal echocardiography.
OBJECTIVE: To evaluate the clinical implication of isolated right dominant heart (RDH) in fetal echocardiography. STUDY DESIGN: We reviewed the medical records of pregnant women diagnosed with fetal RDH at Asan Medical Center from December 1999 to December 2005. The criteria of RDH were the ratio of right-to-left atrial and ventricular width and the ratio of the diameter of pulmonary artery-to-aorta were greater than 1.5. Fetuses with congenital heart disease, including coarctation of the aorta (CoA), noncardiac anomalies or chromosomal abnormalities were excluded. RESULTS: RDH was identified in 44 fetuses. Twenty-nine (66%) were confirmed to have normal heart and 15 (34%) had cardiac anomalies by postnatal echocardiogrphy; 11 CoA, 1 interruption of aortic arch, 1 patent ductus arteriosus, and 2 ventricular septal defect. Mean gestational age at presentation with RDH was later in normal fetuses as compared to fetuses with CoA (p < 0.005). Only 26% (4/15) of fetuses presenting with RDH during the second-trimester were found to have normal heart postnatally, compared with 86% (25/29) of those diagnosed in the third-trimester. CONCLUSION: RDH in the fetus is a risk factor for postnatal CoA particularly when diagnosed in the second-trimester, and should be an indication for neonatal echocardiography.
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Jung et al. (2007) conducted a cohort in Fetal isolated right dominant heart (n=44). Second-trimester diagnosis of right dominant heart vs. Third-trimester diagnosis was evaluated on Normal heart confirmed by postnatal echocardiography. Fetal isolated right dominant heart diagnosed in the second trimester was associated with a lower rate of normal postnatal cardiac anatomy compared to third-trimester diagnosis (26% vs 86%).
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