Echogenic foci in fetal heart from a pediatric cardiologist‘s point of view

Česká verze

Authors: J. Pavlíček ^1,2; E. Klásková ³; S. Kaprálová ³; E. Doležálková ⁴; D. Matura ⁴; R. Špaček ⁴; A. Piegzová ⁴; T. Gruszka ¹; M. Procházka ⁵
Authors place of work: Oddělení dětské a prenatální kardiologie, Klinika dětského lékařství FN a LF OU, Ostrava, primář MUDr. T. Gruszka ¹; Centrum biomedicínského výzkumu FN, Hradec Králové, vedoucí PharmDr. O. Soukup, Ph. D. ²; Dětská klinika FN a LF UP, Olomouc, přednosta prof. MUDr. D. Pospíšilová, Ph. D. ³; Gynekologicko-porodnická klinika FN a LF OU, Ostrava, přednosta doc. MUDr. O. Šimetka, Ph. D. ⁴; Ústav lékařské genetiky FN a LF UP, Olomouc, přednosta prof. MUDr. M. Procházka, Ph. D. ⁵
Published in the journal: Ceska Gynekol 2019; 84(3): 190-194
Category: Původní práce

Summary

Objectives: To evaluate the occurrence and the significance of echogenic foci in the fetal heart and to assess the prognosis of the fetus and child.

Setting: Department of Pediatrics and Prenatal Cardiology, Department of Pediatrics, University Hospital, Faculty of Medicine, Ostrava.

Design: Original article.

Methods: A retrospective study was conducted between 2008–2017. Fetal echocardiography was performed in the second trimester of pregnancy in the study population. The identification of echogenic heart foci, and their follow up during and after the pregnancy were performed by a pediatric cardiologist.

Results: In the monitored period, a total of 27,633 fetuses were examined. Isolated cardiac hyperechogenic foci were detected in 3% (829/27,633) of the fetuses. The foci was found in 93%, 5%, and 2% in the left ventricle, mainly in valvular apparatus of the mitral valve, in the both ventricles, and in the right ventricle, respectively. In 1% (11/829) of the fetuses with cardiac echogenic foci, the others concomitant pathologies (tricuspid regurgitation, extrasystoles, renal pathology) were found. No genetic abnormalities were detected in the fetuses with cardiac hyperechogenic foci.

Conclusion: The echogenic focus in fetal heart is a relatively common, mostly insignificant finding, with any serious consequences for the fetus and the child.

Keywords:

echogenic focus – fetal echocardiography – tumor

Zdroje

1. Arda, S., Sayân, NC., Varol, FG. Isolated fetal intracardiac hyperechogenic focus associated with neonatal outcome and triple test results. Arch Gynecol Obstet, 2007, 276, p. 481–485.

2. Bader, RS., Chitayat, D., Kelly, E., et al. Fetal rhabdomyoma: prenatal diagnosis, clinical outcome, and incidence of associated tuberoussclerosis complex. J Pediatr, 2003, 143, p. 620–624.

3. 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, p. 324–329.

4. Bonnamy, L., Perrotin, F., Megier, P., et al. Fetal intracardiac tumor (s): prenatal diagnosis and management: Three case reports. Eur J Obstet Gyn R B, 2001, 99, 1, p. 112–117.

5. Bromley, B., Lieberman, E., Shipp, TD., et al. Significance of an echogenic intracardiac focus in fetuses at high and low risk for aneuploidy. J Ultras Med, 1998, 17, 2, p. 127–131.

6. Croti, UA., Mattos, SS., Pinto, VC. Jr., et al. Cardiologia e cirurgia cardiovascular pediátrica, 2nd ed, Sao Paulo: Roca, 2012.

7. Davidson, S., Cain, A., Oben, A., Gaither, K. Echogenic intracardiac foci in an urban population: a 10-year retrospective experience. Obstet Gynecol, 2016, p. 127–112.

8. Facio, MC., Hervias-Vivancos, B., Broullon, JR., et al. Cardiac biometry and function in euploid fetuses with intracardiac echogenic foci. Prenat Diagn, 2012, 32, 2, p. 113–116.

9. Fallahian, R., Kalantary, M., Keshavarz, E., Mohammadi, K. Assessing the prevalence of EIF in second trimester ultrasound screening in the fetuses of mothers resorting to Mahdiyeh Medical Center of Tehran from 2014 to 2016 and their follow up. Biomed Pharmacol J, 2017, 10, 2, p. 861–866.

10. Guo, Y., He, Y. Relationship between the location of echogenic intracardiac foci and fetal cardiac anomalies. J Am Coll Cardiol, 2015, 66, 16, Suppl. p. C257–C258.

11. Hamdan, MA., El Zoabi, BA., Al Shamsi, A., et al. Fetal echogenic cardiac foci: prospective postnatal electrocardiographic follow-up. J Perinatol, 2013, 33, 4, p. 268–270.

12. Homola, J. Jsou echogenní fokusy srdečních komor plodu nevýznamným nálezem? Čes Gynek, 1997, 62, s. 280–282.

13. Chu, C., Yan, Y., Ren, Y., et al. Prenatal diagnosis of congenital heart diseases by fetal echocardiography in second trimester: a Chinese multicenter study. Acta Obstet Gyn Scan, 2017, 96, 4, p. 454–463.

14. Jíčínská, H. Prenatální kardiologie v České republice. Čes-slov Pediat, 2010, 65, 11, s. 623–625.

15. Kamil, D., Tepelmann, J., Berg, C., et al. Spectrum and outcome of prenatally diagnosed fetal tumors. Ultrasound Obstet Gynecol, 2008, 31, p. 296–302.

16. Kandasamy, S., Raj, SP. Association between echogenic intracardiac focus in first trimester and biochemical screening – an analysis. J Prenatal Med, 2017, 11, p. 14–17.

17. Lorente, AMR., Moreno-Cid, M., Rodríguez, J., et al. Meta-analysis of validity of echogenic intracardiac foci for calculating the risk of Down syndrome in the second trimester of pregnancy. Taiwan J Obstet Gynet, 2017, 56, 1, p. 16–22.

18. Lubušký, M., Krofta, L., Vlk, R. Pravidelná ultrazvuková vyšetření v průběhu prenatální péče – doporučený postup. Čes Gynek, 2013, 78, Suppl., s. 63–64.

19. Lubušký, M., Krofta, L., Vlk, R., Marková, I. Podrobné hodnocení morfologie plodu při ultrazvukovém vyšetření ve 20.–22. týdnu těhotenství – doporučený postup. Čes Gynek, 2013, 78, 4, s. 390.

20. Mirza, FG., Ghulmiyyah, L., Tamim, H., et al. Echogenic intracardiac focus on second trimester ultrasound: prevalence and significance in a Middle Eastern population. J Matern Fetal Neonatal Med, 2016, 29, 14, p. 2293–2296.

21. Murphy, H., Phillippi, JC. Isolated intracardiac echogenic focus on routine ultrasound: implications for practice. J Middle E Womens St, 2015, 60, 1, p. 83–88.

22. Niewiadomska-Jarosik, K., Stańczyk, J., Janiak, K., et al. Prenatal diagnosis and follow-up of 23 cases of cardiac tumors. Prenat Diagn, 2010, 30, 9, p. 882–887.

23. Perles, Z., Nir, A., Gavri, S., et al. Intracardiac echogenic foci have no hemodynamic significance in the fetus. Pediatr Cardiol, 2010, 31, 1, p. 7–10.

24. Roach, ES., Sparagana, SP. Diagnosis of tuberous sclerosis complex. J Child Neurol, 2004, 19, 9, p. 643–649.

25. Schechter, AG., Fakhry, J., Shapiro, LR., Gewitz, MH. The left ventricular echogenic focus. Am J Roentgenol, 1988, 150, 6, p. 1445–1446.

26. Yu, ZB., Han, SP., Guo, XR. Meta-analysis of the value of fetal echocardiography for the prenatal diagnosis of congenital heart disease. Chin J Evid Based Pediatr, 2009, 4, 4, p. 330–339.

27. Shipp, TD., Bromley, B., Lieberman, E., Benacerraf, BR. The frequency of the detection of fetal echogenic intracardiac foci with respect to maternal race. Ultrasound Obstet Gynecol, 2000, 15, p. 460–462.

28. Sohl, BD., Scioscia, AL., Budorick, NE., Moore, TR. Utility of minor ultrasonographic markers in the prediction of abnormal fetal karyotype at a prenatal diagnostic center. Am J Obstet Gynecol, 1999, 181, p. 898–903.

29. Šamánek, M., Slavík, Z., Zbořilová, B., et al. Prevalence, treatment, and outcome of heart disease in live-born children: A prospective analysis od 91,823 live born children. Pediat Cardiol, 1989, 10, 4, p. 205–211.

30. Šípek, A., Gregor, V., Šípek, A. Jr., et al. Vrozené vady v České republice v období 1994–2007. Čes Gynek, 2009, 74, 1, s. 31–44.

31. Šípek, A., Gregor, V., Šípek, A. Jr., et al. Incidence vrozených srdečních vad v České republice – aktuální data. Čes Gynek, 2010, 75, 3, s. 221–242.

32. Vibhakar, NI., Budorick, NE., Scioscia, AL., et al. Prevalence of aneuploidy with a cardiac intraventricular echogenic focus in an at risk patient population. J Ultras Med, 1999, 18, 4, p. 265–268.

33. Wax, JR., Royer, DJ., Mather, C., et al. A preliminary study of sonographic grading of fetal intracardiac echogenic foci: feasibility, reliability and association with aneuploidy. Ultrasound Obstet Gynecol, 2000, 16, p. 123–127.