Il est possible de faire le diagnostic des malformations cardiaques avant la naissance. Dans certains pays comme la France, presque 70% des cas sont diagnostiqués en anténatal. Ce chiffre est malheureusement encore faible au Maroc mais de gros progrès ont été réalisés au cours des dernières années et les professionnels de santé sont de plus en plus sensibilisés à ce problème de santé publique.
Deux situations peuvent mener au diagnostic:
1. Le gynécologue obstétricien ou l’échographiste qui réalise l’échographie morphologique du deuxième trimestre peut suspecter la malformation au cours de son examen et vous orienter vers un cardiopédiatre qui réalisera une échographie cardiaque foetale spécialisée pour confirmer la malformation.
2. Certaines situations à RISQUE peuvent pousser votre médecin à demander une échographie cardiaque foetale spécialisée systématique:
– En cas d’antécédent de malformation cardiaque chez un de vos enfants ou chez vous ou un membre de votre famille.
– En cas de maladie maternelle comme le diabète, le lupus.
– En cas de prise de médicaments à risque ou de toxiques.
– En cas de grossesse géméllaire
– En cas d’infection virale comme la rubéole
– En cas d’anomalie génétique, chromosomique ou en cas de malformation extra-cardiaque détectée au cours de la grossesse.
– En cas d’augmentation de la clarté nucale visualisée au 1er trimestre.
– Dans certaines situations à risque de la grossesse comme certaines fistules, l’agénésie du ductus venosus, l’hydrops.
L’échographie cardiaque foetale est un examen non invasif qui permet de visualiser le coeur du foetus grâce à un faisceau d’ultrason. C’est exactement la même technique que l’échographie de grossesse mais l’examen est focalisé sur le coeur. Les images sont dynamiques, en temps réel, et permettent d’étudier l’architecture du coeur, sa contractilité, les flux sanguins et ainsi faire le diagnostique de malformations cardiaques in utero.
Le contact avec le gel d’échographie (conducteur) est un peu froid mais cet examen est non douloureux et peut être réalisé dès la 14ème semaine de grossesse (16semaines d’aménorrhée). Il n’est pas nécessaire d’être à jeun ni d’avoir la vessie pleine pour réaliser l’examen.
Quel est l’interêt de faire le diagnostic avant la naissance?
L’expertise du cœur fœtal par le cardiopédiatre permet de poser un diagnostic le plus précis possible.
Une fois le diagnostic établi, les parents peuvent être informés du pronostic de la malformation au cours d’un entretien conseil qui ne peut être réalisé que par des praticiens ayant une longue expérience dans la prise en charges des enfants porteurs de ces malformations.
Le diagnostic de la malformation permet de proposer aux parents la recherche des anomalies génétiques associées par le biais d’une amniocentèse qui n’est pas systématique mais orientée en fonction de la cardiopathie.
Enfin, le diagnostic prénatal permet surtout d’organiser la naissance. En effet, certaines cardiopathies nécessitent la présence d’un cardiopédiatre à la naissance, voire d’un chirurgien cardiaque, ou plus simplement d’un service de réanimation néonatale. Faire le diagnostic permet donc parfois d’améliorer la survie des bébés.
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