Impact and Problems of Fetal Echocardiography: A Single-Institution Study in Japan

Background: The purpose of this study was to assess the current status of prenatal diagnosis and the benefit of fetal echocardiography for complex congenital heart disease (CHD) in Kagawa prefecture. Method: We reviewed 152 cases of CHDs who were born between 2012 and 2020 and performed cardiovascular surgery or catheter intervention in our hospital. They were divided into two groups: the fetal diagnosis group (FD) and the no-fetal diagnosis group (nFD). We compared patient data between FD and nFD groups. Results: Of the 152 patients, 63 patients were FD group and 89 patients were nFD group. The fetal detection rate was lower than 40% between 2012 and 2014, its ratio raise to about 50% after 2015. The ratio of poor general conditions at admission was significantly higher in the nFD group (p<0.01). When focused on hypoplastic left heart syndrome, the number of patients with poor general condition at admission was significantly small in the FD group. Although, the first operation day of life and neonatal death did not show a significant difference between both groups. In total anomalous pulmonary venous connection (TAPVC) cases, 14 cases out of 15 had not been diagnosed prenatally. Among them, the number of cases with poor general condition was nine (64%) and inappropriate usage of oxygen or nitric oxide was 10 cases (71%). Discussion/conclusion: This study suggests that prenatal diagnosis significantly reduces poor general condition at admission. Although the prenatal detection rate grew up, that of TAPVC remains low and their clinical course is poor. In addition, inappropriate therapies were performed. It is desirable to increase the detection rate of TAPVC.