Purpose: In utero congenital heart defect (CHD) diagnosis is challenging and may lead to pregnancy termination. Virtual (CT) post mortem (VPM) is an important diagnostic tool. It can be utilised when pregnancy termination is performed after the 20th week of pregnancy, or when a newborn passes away in the first 24 hour after birth.
The purpose of this study is to compare the prenatal ultrasound (PUS),PM CT and the autopsy results in CHD cases.
Materials and Methods: The study cohort included 13 CHD cases all underwent PUS and VPM. Autopsy was performed in 7 cases. Average gestational age was 31 weeks (range 22-37); pregnancy termination (N= 9) and fetal demise within the first 24 hours (N= 3).
Signed IRB approval was obtained in all cases. CT Scans were performed using a 64 (n=3) and 256 slices (n=10) scanner (Brilliance 64 and ICT SP and, Philips Medical Systems, Cleveland, OH) including arterial and venous administration of iodinated contrast.
Results: Anomalies involved the pulmonary complex (N=6), aortic arch (N=3), cono-truncus (N=3) and an intracardiac tumor (n=1). In 8 cases full agreement was demonstrated between the PUS and the VPM. When autopsy was performed (N=7) complete agreement was documented with both modalities. VPM documented additional pathologies as compared with PUS (N=4): subtotal pulmonary venous anatomy (N=1), aortic coarctation (N=1), Absent radius (N=1) and a complex case where PUS underestimated the extra cardiac and systemic anomalies.
Conclusion: Diagnosis confirmation prior to pregnancy termination or following newborn demise is of major importance. However, autopsy is invasive and presents a problem in certain religious aspects. VPM confirmed the ultrasound diagnosis and added additional information in 4 cases in the current study. Full agreement was demonstrated between VPM and the autopsy results. This suggests VPM might serve as an alternative to autopsy supporting ultrasound diagnosis.
