title: Congenital cardiac anomalies: prenatal readings versus neonatal outcomes.
abstract: OBJECTIVE
  The purpose of this study was to determine the variation between prenatal and postnatal diagnosis of congenital cardiac lesions diagnosed by both fetal center primary physicians and fetal pediatric cardiologists at a single tertiary referral center in the United States and evaluate why cases were misdiagnosed.
  
  
  METHODS
  A retrospective review of all cardiac abnormalities identified prenatally by level II sonography at a tertiary referral fetal center between January 2006 and December 2008 was performed to include any patient with a fetal cardiac abnormality and with a documented autopsy or neonatal follow-up. Congenital heart disease diagnoses were classified as correct, incorrect, or incorrect but within the same spectrum of disease. Cases of correct diagnosis by primary physicians and pediatric cardiologists were compared.
  
  
  RESULTS
  Sixty patients with fetal heart abnormalities were identified among 8894 patients who had level II sonography. The combined detection rate for fetal heart abnormalities for both primary physicians and pediatric cardiologists together was 81.7%. The detection rates of congenital heart disease were not statistically different between primary physicians and pediatric cardiologists: 77.9% (46 of 59) versus 85.0% (34 of 40; P = .3). The most common cardiac abnormalities misdiagnosed in our study population included pulmonic stenosis, ventricular septal defect, myxoma, truncus arteriosus, and coarctation of the aorta.
  
  
  CONCLUSIONS
  Congenital heart disease is misdiagnosed in tertiary care centers by both pediatric cardiologists and fetal imaging specialists. We believe that this occurrence is related to multiple factors, including evolution of congenital heart disease, maternal body habitus, associated congenital anomalies, decreased amniotic fluid volume, gestational age at evaluation, imaging techniques, and, most importantly, the experience of the sonographer.
authors.affiliation: Department of Reproductive Medicine, Perinatal Division, University of California San Diego Medical Center, San Diego, La Jolla, CA 92037, USA.
authors.forename: Neha
authors.initials: N
authors.lastname: Trivedi
authors.forename: Denis
authors.initials: D
authors.lastname: Levy
authors.forename: Maryam
authors.initials: M
authors.lastname: Tarsa
authors.forename: Tracy
authors.initials: T
authors.lastname: Anton
authors.forename: Caitlin
authors.initials: C
authors.lastname: Hartney
authors.forename: Tanya
authors.initials: T
authors.lastname: Wolfson
authors.forename: Dolores H
authors.initials: DH
authors.lastname: Pretorius
mesh_terms: D000328:Adult; D001344:Autopsy; D016009:Chi-Square Distribution; D002983:Clinical Competence; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal; D014481:United States