Extended fetal echocardiographic examination for detecting cardiac malformations in low risk pregnancies.

Achiron, R.; Glaser, Joram; Gelernter, Ilana; Hegesh, Julius; Yagel, Simcha

doi:10.1136/bmj.304.6828.671

Cited by 240 publications

(173 citation statements)

References 10 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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“…In our country, most fetal examinations are covered by major health insurance organizations. Fetal cardiac examination is standardized using the extended protocol for fetal echocardiography, as previously reported by us [6][7][8][9] . This routinely includes seven sonographic views: (1) transverse view of the upper abdomen; (2) four-chamber view; (3) longitudinal left outflow tract; (4) short-axis view for right outflow tract; (5) longitudinal view for aortic arch and ductus; (6) longitudinal view for systemic veins; and (7) upper axial mediastinal, three-vessel view combined with tracheal location for aortic arch abnormalities.…”

Section: Accepted 21-8-02 Ultrasound In Obstetrics and Gynecologymentioning

confidence: 99%

Anomalies of the fetal aortic arch: a novel sonographic approach to in‐utero diagnosis

Achiron

Rotstein

Heggesh

et al. 2002

Ultrasound in Obstet & Gyne

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“…Na nossa série a inclusão dos cortes eixo longo e eixo curto na avaliação do nível I foram determinantes para a detecção de 25% das alterações estruturais e pode explicar a sensibilidade de 72%, em concordância com outros estudos importantes que obtiveram taxas de detecção superiores a 70% 13,14 .…”

Section: Discussionunclassified

“…Congenital heart disease; Echocardiography/diagnostic use; Prenatal diagnosis; Fetal diseases/ ultrasonography; Heart defects, congenital/ultrasonography cular e interrupção do arco aórtico, pois neste plano os grandes vasos não são visualizados e o coração pode ser interpretado como normal na presença destas malformações 13 . Para o completo rastreamento destas malformações é necessária a abordagem de pelo menos dois outros cortes básicos, os eixos longo e curto.…”

Section: Introductionunclassified

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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Extended fetal echocardiographic examination for detecting cardiac malformations in low risk pregnancies.

Cited by 240 publications

References 10 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

Anomalies of the fetal aortic arch: a novel sonographic approach to in‐utero diagnosis

Rastreamento e diagnóstico ecocardiográfico das arritmias e cardiopatias congênitas fetais

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