Concordance Between Obstetric Anatomic Ultrasound and Fetal Echocardiography in Detecting Congenital Heart Disease in High‐risk Pregnancies

Abstract

Objectives To evaluate the concordance between second‐trimester anatomic ultrasound and fetal echocardiography in detecting minor and critical congenital heart disease in pregnancies meeting American Heart Association criteria. Methods We conducted a retrospective cohort study of pregnancies in which a second‐trimester fetal anatomic ultrasound examination (18–26 weeks) and fetal echocardiography were performed between 2012 and 2018 at our institution based on American Heart Association recommendations. Anatomic ultrasound studies were interpreted by maternal‐fetal medicine specialists and fetal echocardiographic studies by pediatric cardiologists. Our primary outcome was the proportion of critical congenital heart disease (CCHD) cases not detected by anatomic ultrasound but detected by fetal echocardiography. The secondary outcome was the proportion of total congenital heart disease cases missed by anatomic ultrasound but detected by fetal echocardiography. Neonatal medical records were reviewed for all pregnancies when obtained and available. Results Overall, 722 studies met inclusion criteria. Anatomic ultrasound and fetal echocardiography were in agreement in detecting cardiac abnormalities in 681(96.1%) studies (κ = 0.803; P < .001). The most common diagnosis not identified by anatomic ultrasound was a ventricular septal defect, accounting for 9 of 12 (75%) missed congenital heart defects. Of 664 studies with normal cardiac findings on the anatomic ultrasound examinations, no additional instances of CCHD were detected by fetal echocardiography. No unanticipated instances of CCHD were diagnosed postnatally. Conclusions With current American Heart Association screening guidelines, automatic fetal echocardiography in the setting of normal detailed anatomic ultrasound findings provided limited benefit in detecting congenital heart defects that would warrant immediate postnatal interventions. More selective use of automatic fetal echocardiography in at‐risk pregnancies should be explored.

The Utility of Screening Fetal Echocardiograms Following Normal Level II Ultrasounds in Fetuses with Maternal Congenital Heart Disease

“…These previous studies have noted an approximately 2–3% missed CHD diagnosis rate on the second-trimester screening ultrasound when compared to an F-echo in the current era [ 13 , 18 ]. The possibility of a missed critical CHD when there was a prior normal second-trimester screening ultrasound was < 0.5% in large population studies [ 13 , 19 , 20 ]. The estimated number of F-echo needed to be performed to detect a missed critical CHD ranged from 249 to 750 [ 13 , 20 ].…”

Foetal Echocardiography vs. Neonatal Echocardiography for Diagnosis of Congenital Heart Diseases

“…(Bravo-Valenzuela et al, 2018) Because of the restricted fetal position and limited amniotic fluid, late gestation imaging is more difficult. This explains why it is critical to identify and refer suspected abnormalities as soon as possible [24]. Mamalis et al found that double outlet right ventricle and right heart anomalies had slightly lower diagnosis accuracy.…”

Modern Possibilities of Ultrasound Diagnostics of Fetal Heart Defects

“…В то же время в соответствии с текущими рекомендациями по скринингу Американской кардиологической ассоциации автоматическая эхокардиография в период внутриутробного развития при визуализированных нормальных характеристиках сердца приносит ограниченную пользу в выявлении врожденных пороков сердца, требующих немедленных послеродовых вмешательств. Исследователи отмечают, что следует изучить возможность более избирательного использования автоматической эхокардиографии плода в условиях повышенного риска ВПС [19].…”