Classification of Fetal Congenital Heart Disease by Prenatal Ultrasound and Its Diagnostic Value.

Purpose: To evaluate diagnostic value of prenatal ultrasound in classifying fetal congenital heart disease (CHD) and to verify its diagnostic accuracy by comparing its results with postnatal pathological findings.

Methods: This retrospective study analyzed 372 pregnant women with fetal CHD, detected by ultrasound, who underwent interventional prenatal diagnosis. Prenatal CHD cases were classified at three levels. Pathological and anatomical examinations of CHD fetuses were performed in 305 pregnant women who terminated pregnancies; results were compared to those of prenatal ultrasonography.

Results: At first classification level, complex type accounted for 37.6% (140/372), predominated by double outlet right ventricle (DORV); severe 36.6% (136/372), represented by tetralogy of Fallot (TOF); and simple 25.8% (96/372), commonly ventricular septal defect (VSD). At second classification level, incidence of isolated was higher than that of syndromic [55.9% (212/372) vs 42.2% (160/372), P<0.05]. Facial dysplasia 24.2% (90/372) and skeletal system malformations 12.4% (46/372) were common. Incidence of simple CHD did not vary between isolated and syndromic [OR=1.017, 95% CI (0.636,1.626), P=0.945]. In contrast, incidence of severe [OR=2.126, 95% CI (1.366, 3.310), P<0.001] was high in isolated and that of complex [OR=0.478, 95% CI (0.312, 0.732), P<0.001] was high in syndromic. At third classification level, valvular disease accounted for 57.3% (213/372), and conotruncal defects (CTDs) 57.0% (212/372), were more prevalent in congenital cardiovascular anomalies. Incidences of VSD 70.4% (150/213) were high in all valvular diseases, with combined intracardiac and extracardiac malformations being 58% (87/150) and 42.7% (64/150), respectively. Among CTDs, TOF 25.5% (54/212) was common. Prenatal ultrasound and postnatal pathology revealed 92.5% (282/305) coincidence rate in CHD diagnoses.

Conclusion: Three-level classification method enables a comprehensive analysis of prenatal diagnosis and prognosis for fetal CHD, facilitating timely decision-making in clinical settings. Prenatal ultrasound plays an essential role in CHD diagnosis, facilitating implementation of clinical interventions tailored at halting this menace.