Role of Prenatal Echocardiographic Diagnosis in Early Postnatal Management of Congenital Heart Disease at a Single Center Without Neonatal Cardiac Surgery.

Abstract

Background: Fetal echocardiography is essential for the prenatal diagnosis of congenital heart disease (CHD) and plays a key role in planning early postnatal management, delivery, and inter-facility transfer. However, prenatal diagnoses do not always correspond to postnatal diagnoses, and diagnostic discordance occurs at a certain frequency. This issue is particularly relevant in centers without neonatal cardiac surgery, where the clinical value of prenatal diagnosis must be evaluated primarily in the context of early neonatal management.

Methods: We retrospectively reviewed 43 cases in which fetal echocardiography was performed collaboratively by pediatric cardiologists and obstetricians specializing in fetal echocardiography at our institution between 2014 and 2021, with a prenatal diagnosis of CHD and a confirmed postnatal diagnosis. The concordance between prenatal and postnatal primary diagnoses was assessed. The primary endpoint was whether clinically significant changes in early postnatal management were required compared with prenatal expectations.

Results: Prenatal and postnatal primary diagnoses were discordant in seven cases (16%). In most discordant cases, the anticipated circulatory physiology and early management strategies remained appropriate after birth. Only two cases (5%) required clinically significant changes in early postnatal management. In one case, anticipated early postnatal hemodynamic instability due to an unrecognized systemic outflow obstruction prompted an urgent transfer to a specialized cardiac center after birth. In the other case, unanticipated duct-dependent systemic circulation required early postnatal medical management to support systemic circulation. Subsequent evaluation revealed multiple extracardiac anomalies, and genetic testing confirmed a severe chromosomal syndrome with a poor life prognosis. After extensive discussion with the family, cardiac surgery was not pursued.

Conclusion: The role of prenatal echocardiographic diagnosis of CHD lies not in achieving complete diagnostic concordance, but in accurately anticipating hemodynamic risks requiring early postnatal intervention. Even in centers without neonatal cardiac surgery, prenatal echocardiography supports appropriate early postnatal management and facilitates timely coordination with specialized cardiac centers.