Neonatal management and outcomes of prenatally diagnosed CHDs

Bensemlali, Myriam; Bajolle, Fanny; Laux, Daniéla; Parisot, Pauline; Ladouceur, Magalie; Fermont, L; Lévy, Marilyne; Bidois, J. Le; Raimondi, Francesca; Ville, Y.; Salomon, Laurent; Boudjemline, Younès; Bonnet, Damien

doi:10.1017/s1047951116000639

Cited by 22 publications

(15 citation statements)

References 36 publications

(60 reference statements)

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“…Prenatal diagnosis of isolated TAPVC is still thought to be very difficult . In fact, only one fetus was diagnosed prenatally out of eight with TAPVC in the previous study period (2005‐2013) .…”

Section: Discussionmentioning

confidence: 99%

“…Prenatal diagnosis of isolated TAPVC is still thought to be very difficult. [5][6][7] In fact, only one fetus was diagnosed prenatally out of eight with TAPVC in the previous study period (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) We think that this simple index is useful for raising the suspicion of anomalous pulmonary venous return, allowing referral of these fetuses to centers where specialists can perform fetal echocardiography.…”

Section: Mao Et Al Measured the Distance Between The La And Descendingmentioning

confidence: 98%

“…We previously reported that this space is wider in fetuses with total anomalous pulmonary venous connection (TAPVC), a rare form of severe congenital heart disease that requires emergency neonatal surgery associated with a high mortality . It is still difficult to detect TAPVC prenatally because the four‐chamber view looks normal . We reported that the post‐LA space index (PLAS index) is significantly higher in fetuses with TAPVC than in normal fetuses, suggesting this index may be useful for detecting TAPVC .…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the post‐LA space index in the normal fetus

et al. 2019

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Objective We previously reported the post‐LA space index (PLAS index), which is calculated as left atrial‐descending aorta distance (LD) divided by the diameter of descending aorta (DA), could be useful for prenatal diagnosis of total anomalous pulmonary venous connection (TAPVC). In this study, we evaluated PLAS index in normal fetuses to assess its usefulness. Methods In 304 normal fetuses, LD and DA were retrospectively measured, and the PLAS index was calculated. In 206 fetuses with data on the biparietal diameter (BPD) and femoral length (FL), the relationship between the PLAS index and them was investigated. We also calculated the PLAS index in 13 TAPVC fetuses. Results Mean LD was 3.0+/−0.94 mm, mean DA was 4.8+/−0.87 mm, and the mean PLAS index was 0.62+/−0.19. DA and LD were correlated with gestational age (R = 0.52, 0.25), while the PLAS index showed little variation with gestational age (R < 0.2). BPD and FL were correlated with DA (R = 0.4, 0.42) but not with LD or the PLAS index (both R < 0.2). In the TAPVC fetuses, both LD and the PLAS index were significantly higher than in normal fetuses. Conclusion In normal fetuses, the PLAS index was independent of gestational age and fetal physique and may be useful for raising the suspicion of congenital heart disease, including TAPVC.

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Section: Discussionmentioning

confidence: 99%

Section: Mao Et Al Measured the Distance Between The La And Descendingmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Evaluation of the post‐LA space index in the normal fetus

et al. 2019

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“…The result was OB-4000, which comprised 4,473,852 images. As an external testing set, we received 423 fetal echocardiograms (4,389 images from 32 normal studies and 40,123 images from 391 abnormal studies) from Boston Children's Hospital. These training and test sets are summarized in Table 1 and Figure S1d.…”

Section: Data Setsmentioning

confidence: 99%

“…Congenital heart disease (CHD), the most common birth defect 1 , can be asymptomatic in fetal life but cause significant morbidity and mortality after birth [1][2][3] . Compared to postnatal diagnosis, fetal diagnosis can improve neonatal outcomes, surgical/interventional planning [4][5][6] , and could enable in utero therapies 7,8 . Distinguishing normal fetal hearts from complex CHD requiring referral to a fetal cardiologist is therefore a critical and universal need, especially at a time when the COVID-19 pandemic has further limited patient access to prenatal care 9 .…”

Section: Introductionmentioning

confidence: 99%

Expert-level prenatal detection of complex congenital heart disease from screening ultrasound using deep learning

Arnaout

Curran

Zhao

et al. 2020

Preprint

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Congenital heart disease (CHD) is the most common birth defect. Fetal survey ultrasound is recommended worldwide, including five views of the heart that together could detect 90% of complex CHD. In practice, however, sensitivity is as low as 30%. We hypothesized poor detection results from challenges in acquiring and interpreting diagnostic-quality cardiac views, and that deep learning could improve complex CHD detection. Using 107,823 images from 1,326 retrospective echocardiograms and surveys from 18-24 week fetuses, we trained an ensemble of neural networks to (i) identify recommended cardiac views and (ii) distinguish between normal hearts and complex CHD. Finally, (iii) we used segmentation models to calculate standard fetal cardiothoracic measurements. In a test set of 4,108 fetal surveys (0.9% CHD, >4.4 million images, about 400 times the size of the training dataset) the model achieved an AUC of 0.99, 95% sensitivity (95%CI, 84-99), 96% specificity (95%CI, 95-97), and 100% NPV in distinguishing normal from abnormal hearts. Sensitivity was comparable to clinicians' task-for-task and remained robust on external and lower-quality images. The model's decisions were based on clinically relevant features. Cardiac measurements correlated with reported measures for normal and abnormal hearts. Applied to guidelines-recommended imaging, ensemble learning models could significantly improve detection of fetal CHD and expand telehealth options for prenatal care at a time when the COVID-19 pandemic has further limited patient access to trained providers. This is the first use of deep learning to approximately double standard clinical performance on a critical and global diagnostic challenge.

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The Left Outflow Tract in Fetal Cardiac Screening Examination

Mancini

Lafouge³

et al. 2023

J of Ultrasound Medicine

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ObjectivesSince 2016, the French CNEOF included the left ventricular outflow tract (LVOT) in the second and third trimester of pregnancy in addition to the four‐chamber view and the parasagittal view of the right outflow tract. The objective of this study was to define quality criteria for fetal LVOT assessment and to perform a human audit of past and current practices, before and after the implementation of those quality criteria at a large scale.MethodsSeven quality criteria were investigated and rated from 0 to 1 during three periods of interest. Files were randomly selected from three centers, and average total and specific scores were calculated.ResultsLVOT pictures were present in more than 94.3% of reports. The average quality score was 5.49/7 (95% confidence interval [CI]: 5.36–5.62), 5.91/7 (95% CI: 5.80–6.03), and 5.70/7 (95% CI: 5.58–5.82) for the three centers in the three periods of interest. There was no significant difference following the introduction of the quality criteria, 2017 versus 2020, P = .054.ConclusionFetal LVOT images were present in most of ultrasound reports but the introduction of the proposed quality criteria under human supervision seems not associated with a significant change in practice.

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Neonatal management and outcomes of prenatally diagnosed CHDs

Cited by 22 publications

References 36 publications

Evaluation of the post‐LA space index in the normal fetus

Evaluation of the post‐LA space index in the normal fetus

Expert-level prenatal detection of complex congenital heart disease from screening ultrasound using deep learning

The Left Outflow Tract in Fetal Cardiac Screening Examination

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