Evaluation of prenatal diagnosis of congenital heart diseases by ultrasound: experience from 20 European registries

Garne, Ester; Stoll, Claude; Clementi, Maurizio

doi:10.1046/j.1469-0705.2001.00385.x

Cited by 321 publications

(289 citation statements)

References 19 publications

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“…Unfortunately, most population studies regarding the use of ultrasonography to detect congenital heart disease have reported low sensitivities for abnormalities of the great arteries [10,12,13,28,41,42,63,64]. Studies documenting higher detection rates emphasized routine visualization of the outflow tracts in addition to the usual four-chamber view [8,22,24,25,27,32,36,37,[65][66][67].…”

Section: Discussionmentioning

confidence: 99%

Four-dimensional fetal echocardiography with spatiotemporal image correlation (STIC): A systematic study of standard cardiac views assessed by different observers

Gonçalves

Espinoza

Romero

et al. 2005

The Journal of Maternal-Fetal & Neonatal Medicine

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Methods.A technique was developed to obtain dynamic multiplanar images of the left ventricular outflow tract (LVOT) and right ventricular outflow tract (RVOT) from volume datasets acquired with STIC. Volume datasets were acquired from fetuses with normal cardiac anatomy. Twenty volume datasets of satisfactory quality were pre-selected by one investigator. The data was randomly assigned for a blinded review by two independent observers with previous experience in fetal echocardiography. Only one volume dataset was used for each fetus. After a training session, the observers obtained standardized cardiac views of the LVOT and RVOT, which were scored on a scale of 1 to 5, based on diagnostic value and image quality (1 = unacceptable, 2 = marginal, 3 = acceptable, 4 = good, and 5 = excellent). Median scores and interquartile range, as well as inter-and intraobserver agreement were calculated for each view. Results. The mean menstrual age at the time of volume acquisition was 25.5 + 4.5 weeks. Median scores (interquartile range) for LVOT images, obtained by the first and second observers, were 3.5 (2.25-5.00) and 4 (3.00-5.00), respectively. The median scores (interquartile range) for RVOT images obtained by the first and second observers were 3 (3.00-5.00) and 3 (2.00-4.00), respectively. The interobserver intraclass correlation coefficient for the LVOT was 0.693 (95% CI 0.380-0.822), and 0.696 (95% CI 0.382-0.866) for the RVOT. For the intraobserver agreement analysis, observer 1 gave higher scores to the LVOT the second time the volumes were analyzed [LVOT: 3.50 (2.25-5.00) vs. 5.00 (4.00-5.00, p = 0.008)]. Conclusion. STIC can be reproducibly used to evaluate fetal cardiac outflow tracts by independent examiners. Slightly better image quality rating scores during the intraobserver variability trial suggests the presence of a learning curve for the manipulation and analysis of volume data obtained by STIC.

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Section: Discussionmentioning

confidence: 99%

Four-dimensional fetal echocardiography with spatiotemporal image correlation (STIC): A systematic study of standard cardiac views assessed by different observers

Gonçalves

Espinoza

Romero

et al. 2005

The Journal of Maternal-Fetal & Neonatal Medicine

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“…Furthermore, four of 1000 live births will be affected by severe congenital cardiac malformations, which account for 20% of neonatal deaths and up to 50% of infant deaths attributed to congenital anomalies (2,6). Nevertheless differences exist in the rates of prenatal diagnosis and termination of CHDs across populations, and through time (7)(8)(9), which has an impact on the live birth prevalence of the more severe cases of CHDs, particularly for hypo-plastic left heart syndrome (HLHS) and related morbidity and mortality (3,10). Counseling of parents has become increasingly essential, as the frequency of detecting of fetal abnormalities has increased.…”

Section: Introductionmentioning

confidence: 99%

Counseling and outcomes of antenatally diagnosed congenital heart anomalies in Turkey

Gedikbaşı¹,

Öztarhan²,

Yıldırım³

et al. 2011

Anadolu Kardiyol Derg

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ÖZETAmaç: Prenatal tanı almış, fetal kalp anomalilerinin, klinik sonuçları ve aile kararlarının değerlendirilmesi. Yöntemler: Prenatal doğumsal kalp anomali tanısı konmuş olgular (n=155), retrospektif yöntemle Allan ve Huggon'ın sınıflandırması doğrultu-sunda, Grup A (doğumsal kalp anomalisine eşlik eden ağır / ölümcül kalp dışı patoloji); Grup B1 (postnatal prognoz açısından düşük risk), Grup B2 (orta risk, düşük mortalite oranı ile uyumlu cerrahi mortalite) ve Grup B3 (yüksek risk-cerrahi sonrası için yüksek mortalite) olarak sınıflan-dırıldı. Ailelere verilen, danışma sonrası yenidoğan verileri, buna gebelik sonlandırması dahil edilmiştir ve 18 ay süreyle izlendi. Bulgular: Olguların 145'inin izlemi tam olarak gerçekleştirilmiştir. Otuz dokuz olguda (Grup A) eşlik eden ölümcül kalp dışı anomaliler saptanmış-tır ve bunların gebelik sonlandırılmasına karar verilmiştir; bu olgular istatistiksel değerlendirmeye alınmamıştır. Grup B3' teki olguların 20 tanesi de gebelik sonlandırmasına karar verdi. Diğer üç kalp anomalisi gruplarında, gebeliğin devamına karar veren ailelerde (Grup B1, n=37; Grup B2, n=12; Grup B3, n=37), 18 ayın sonunda sağkalım oranları sırasıyla %89.2, %66.7 ve %13.5 bulunmuştur. İstatistiksel verilerin değerlendirmesinde Student's t-test, Mann-Whitney U, Pearson's Ki-kare testi ve Fischer's exact Ki-kare testi uygulanmıştır. Sağkalım açısından 3 grupta istatistiksel anlamlılık saptanmıştır [Grup B3 ile Grup B1: p=0.0001; OR: 52.8 (12.9-214.5); Grup B3 ile Grup B2: p=0.0009; OR: 12.8 (2.8-58.9); Grup B2 ile Grup B1: p=0.087; OR: 4.12 (0.84-20.2)]. Sonuç: Uygulamalarımız ve istatistiksel sonuçlarımız, bu sınıflama sisteminin, doğumsal kalp anomalileri açısından ebeveynlere verilecek danış-mada etkili olduğunu gösterdi. ABSTRACTObjective: To determine the clinical outcomes and decisions of families of fetuses with prenatally-diagnosed cardiac abnormalities. Methods: Prenatally diagnosed cases (n=155) with congenital heart disease were retrospectively categorized according to the Allan-Huggon grading system: Group A (cardiac disease associated with severe / lethal extracardiac disease); Group B1 (low risk with a postnatal prognosis); Group B2 (moderate risk, amenable to surgical repair with a low mortality); and Group B3 (high risk, associated with high mortality after surgery). Neonatal outcomes, including termination of pregnancy, were recorded for 18 months of follow-up after counseling the parents. Student's t-test, Mann-Whitney U, Pearson's Chi-square test and Fischer's exact Chi-square test were used for statistical analyses. Results: One hundred forty-five cases completed follow up. Thirty-nine cases (Group A) were associated with extracardiac lethal defects and the pregnancies were terminated; these cases were excluded from statistical evaluation. Twenty parents in Group B3 opted also for termination. The survival rates of ongoing pregnancies after 18 months of follow-up between the three cardiac abnormality Groups (Group B1, n=37; Group B2, n=12; and Group B3, n=37) were 89.2%, 66.7%, and...

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“…Em avaliação realizada em 20 centros europeus, observou-se que o rastreamento obtido pelo nível I apresenta taxas de detecção que variam entre 8 a 48%, de acordo com o grau de treinamento dos obstetras e ultra-sonografistas na obtenção dos cortes ecocardiográficos básicos 18 .…”

Section: Discussionunclassified

Rastreamento e diagnóstico ecocardiográfico das arritmias e cardiopatias congênitas fetais

Carvalho¹,

Mendes²,

Cavalli³

et al. 2006

Rev. Bras. Ginecol. Obstet.

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RESUMOObjetivo: analisar os resultados obtidos em programa de rastreamento e diagnóstico de arritmias e cardiopatias congênitas centrado em uma unidade terciária e determinar a importância do diagnóstico precoce na evolução fetal e neonatal. Método: foram analisados os resultados da avaliação cardíaca fetal efetuada em 1159 gestantes em dois níveis diferentes. Nível I: uso da ultra-sonografia morfológica com o objetivo de rastrear a presença de alteração cardíaca, sem estabelecer um diagnóstico diferencial. Nível II: por ecocardiograma fetal com o objetivo de diagnosticar as cardiopatias fetais existentes. Os resultados da detecção de arritmias bem como da avaliação das alterações estruturais foram comparados, sendo estabelecidas a sensibilidade e a especificidade para ambos os níveis no pré-natal, ao exame pós-natal ou à necropsia. A concordância entre ambos os níveis foi calculada pelo índice kappa. Resultados: as arritmias detectadas no nível I foram confirmadas em todos os casos e não houve falso-negativos, sendo que em cinco pacientes houve necessidade de tratamento intra-útero. A detecção das alterações estruturais obtidas no nível I teve sensibilidade de 72% e especificidade de 98%, com 28% de falso-positivos. No nível II estes parâmetros foram, respectivamente, de 100 e 99%. De acordo com o coeficiente kappa de 57%, um grau de concordância de categoria moderada foi observado entre ambos os níveis. Das cardiopatias congênitas da nossa série 51% necessitaram intervenção farmacológica ou invasiva no período neonatal. Conclusão: o estudo ultra-sonográfico obstétrico é fundamental no rastreamento das alterações cardíacas fetais. O ecocardiograma fetal apresentou alto índice de sensibilidade e especificidade no diagnóstico das arritmias e cardiopatias congênitas, possibilitando o tratamento precoce das alterações graves. PALAVRAS-CHAVE: Cardiopatias congênitas; Diagnóstico pré-natal; Ecocardiografia/uso diagnóstico; Doenças fetais/ ultrasonografia; Cardiopatias congênitas/ultrasonografiaABSTRACT Purpose: to analyze the results of a screening and diagnostic program of arrhythmias and congenital heart disease in a reference hospital and the relevance of early diagnosis in the fetal and neonate evolution. Method: cardiac evaluation of 1159 fetuses was done in two different levels. Level I: by morphological ultrasound examination with the objective to detect the existence of either arrhythmias or structural cardiac malformations. Level II: by fetal echocardiography to establish the differential diagnosis. The results of level I in the arrhythmia group were compared with those of level II, and in the group with malformations the results of both levels were confronted with the neonate echocardiogram or necropsy. The kappa index was calculated to evaluate the concordance between the two levels. Results: all detected arrhythmias in level I were confirmed in level II, there were no false negative cases and five patients with severe arrhythmia required pharmacological therapy. The diagnosis of structural malformation by...

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Evaluation of prenatal diagnosis of congenital heart diseases by ultrasound: experience from 20 European registries

Abstract: Prenatal detection rate of congenital heart disease varies significantly between countries even with the same screening recommendations. The presence of associated malformations significantly increases the prenatal detection rate.

Cited by 321 publications

References 19 publications

Four-dimensional fetal echocardiography with spatiotemporal image correlation (STIC): A systematic study of standard cardiac views assessed by different observers

Four-dimensional fetal echocardiography with spatiotemporal image correlation (STIC): A systematic study of standard cardiac views assessed by different observers

Counseling and outcomes of antenatally diagnosed congenital heart anomalies in Turkey

Rastreamento e diagnóstico ecocardiográfico das arritmias e cardiopatias congênitas fetais

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