Screening for congenital heart disease with the four-chamber view of the fetal heart

Vergani, Patrizia; Mariani, Silvana; Ghidini, Alessandro; Schiavina, Riccardo; Cavallone, Maria; Locatelli, Anna; Strobelt, Nicola; P, Cerruti

doi:10.1016/s0002-9378(12)80027-5

Cited by 77 publications

(54 citation statements)

References 6 publications

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“…Copel et al (20) advocate that sensitivity of four-chamber view is higher, whereas other authors consider this approach as low sensitive (4-40%) (14)(15)(16)(17)(18)(19)(20)(21). Usually FE studies report that fourchamber view has low sensitivity, obstetric ultrasound studies report high sensitivity.…”

Section: Discussionmentioning

confidence: 99%

The results of fetal echocardiography in a tertiary center and comparison of low- and high-risk pregnancies for fetal congenital heart defects

Özkutlu¹,

Akça²,

Kafalı³

et al. 2010

Anadolu Kardiyol Derg

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Objective: Fetal echocardiography (FE) is considered for fetal, maternal or hereditary reasons in pregnants with suspect of intrauterine heart disease (IUHD). However, in few studies it was reported that most of the fetuses with IUHD are in the low-risk group (suspicion of IUHD during 2 nd trimester ultrasound, lack of good vision of the heart, self-referral). Our aim is to examine retrospectively the reasons for referral of pregnants, the results of FE, distribution of pregnants having fetuses with IUHD according to low-and high-risk factors and to evaluate reliability of FE. Methods: Our study group consisted of 1395 fetuses and 1370 pregnants underwent FE between 1999 and 2006. These cases included selfreferred women and the pregnants having previous child or family history of cardiac anomaly or referred by obstetricians. The prevalence of IUHDs in low-and high-risk pregnancies was compared by Chi-Square test. Results: The low risk group included 453 patients and the remaining 917 women were in the high-risk group. Intrauterine heart diseases were detected in 152 (10.9%) of 1395 fetuses. The prevalence of IUHDs was 19% in the low-risk group and 7% in the high-risk group. Of the152 fetuses 56.6% were in the low-risk group and 43.4% were in the high-risk group. The sensitivity of FE for diagnose of IUHDs was 97%, the specificity was 100%. Conclusion: Fetal echocardiography is highly reliable method for diagnosing of IUHDs. The most IUHDs occur in the low-risk group. (Anadolu Kardiyol Derg 2010; 10: 263-9) Key words: Fetal echocardiography, congenital heart disease, indication, low-risk and high-risk factors ÖZET Amaç: Fetal, maternal ve herediter nedenlerle FE yapılan gebeler, konjenital kalp hastalıklı (KKH) fetusa sahip olma olasılığı yüksek olan gebelerdir. Ancak yapılan çok az sayıdaki çalışmada KKH'lı fetusların çoğunun düşük riskli (ikinci trimester ultrasonunda KKH şüphesi, kalbin iyi görüntülene-memesi, gebelerin kendi istediğiyle başvurması) gebelik grubuna dahil olduğu bildirilmiştir. Bu çalışmada bölümümüzde son yıllarda FE'si yapılan gebelerin başvuru nedenlerini, ekokardiyografi sonuçlarını ve fetuslarında KKH'ı olan gebelerin düşük ve yüksek risk faktörlerine göre dağılımlarını ve FE sonuçlarımızın güvenilirliğini retrospektif olarak değerlendirdik. Yöntemler: Çalışmamızda Ekim 1999-Haziran 2006 tarihleri arasında Ünitemizde 1536 gebeye FE yapıldı. Postnatal ekokardiyografi sonucu bilinen 1243 normal kalp bulguları olan fetus ile postnatal ekokardiyografisi ve/veya otopsisi bilinen 152 intrauterin kalp hastalıklı (IUKH) fetus olmak üzere toplam 1395 fetus ve 1370 gebe çalışma grubumuzu oluşturdu. Bu olgular, kadın hastalıkları ve doğum uzmanları tarafından yönlendirilen, kendi isteğiyle başvuran ve ailesinde veya daha önceki gebeliklerinde KKH'ğı olan gebelerden oluşmaktadır. Düşük ve yüksek riskli gebelerdeki IUKH'ğı prevalansı Ki-Kare testiyle karşılaştırılmıştır. Bulgular: Düşük risk grubunda 453 (%33.1), yüksek risk grubunda 917 (%66.9) gebe yer almaktaydı. 1395 fetusun 152'sinde (%10.9) IUKH ...

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Section: Discussionmentioning

confidence: 99%

The results of fetal echocardiography in a tertiary center and comparison of low- and high-risk pregnancies for fetal congenital heart defects

Özkutlu¹,

Akça²,

Kafalı³

et al. 2010

Anadolu Kardiyol Derg

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“…4) [3]. Those who advocate using only the four-chamber view for the routine evaluation of the fetus have suggested that the sensitMty for the detection of cardiac abnormalities is suff icient without specifically imaging the great vessels [2]. We and other groups have shown that it is necessaryto evaluate the aortic and pulmonary outflow tracts in order to detect many of the ductus-dependent lesions [3][4][5].…”

Section: Great Vessel Abnormalities That Often Results In a Normal Foumentioning

confidence: 99%

Sonographic detection of fetal anomalies of the aortic and pulmonary arteries: value of four-chamber view vs direct images.

Benacerraf

1994

American Journal of Roentgenology

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Some investigatorssupport the notion that the four-chamber view of the fetal heart is sufficient for the sonographic identification of most serious heart defects (1 , 2]. We have found that the evaluation of the great vessels (aorta and pulmonary artery) Is crucial for the detection of some of the most common heart defects, such as tetralogy of Fallot and transposition of the great arteries [3][4][5]. Although many abnormalities of the great vessels This pictorial essay illustrates abnormalities of the great vessels and shows those likely to be identified with a four-chamber view as opposed to those that require direct Images of the great yessels for detection.

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“…13 Confirmation of the diagnosis led to a multidisciplinary approach, with involvement of a pediatric cardiologist, a geneticist, and the obstetrician, so that the most accurate information could be given to the parents to help them in the decision-making process. 6 Perioperative morbidity and mortality are lower for prenatally diagnosed cardiac lesions, as delivery can be arranged in a center with adequate neonatal resuscitation and surgical facilities 13 .…”

Section: Graph 2 Discussionmentioning

confidence: 99%

“…The highest incidence of (50) % of congenital heart disease occurs in cases referred because of a suspected congenital heart disease on a routine ultrasonographic scan. 6 Wernovsky et al, mention that a continuation of the application of the arterial switch operation to patients with transposition of the great arteries with or without VSD, as early in life as is possible, is indicated. 14 Brawn and Mee et al, advocate anatomic repair of TGA-VSD and DORV-VSD before 3 months of age to correct symptoms of congestive failure to thrive and to prevent the development of pulmonary vascular disease.…”

Section: Graph 2 Discussionmentioning

confidence: 99%

Transabdominal Sonographic Quantitative Analysis of the Fetal Cardiac Width in Third Trimester of Gestation

Yerolavi¹,

Natarajan²

2014

jemds

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Antenatal ultrasonography is noninvasive and done on routine basis in our institution. A four chamber view of the fetal heart is done as a part of regular sonographic examination of the fetus. Most cases of congenital heart disease are of structural rather than functional origin. The heart grows very rapidly during the third trimester (positive allometry). The linear increase of the fetal heart shows a strong and significant correlation with the increase of both femur length and BPD. This suggests that non-invasive analysis of cardiac data can be useful for prenatal detection of congenital heart disease or for the gestational age. 1 If a malformation is diagnosed in the third trimester, the fetus should be delivered at a facility equipped to care of the infant with congenital heart disease. The fetal heart was studied with transabdominal sonography in 132 single normal pregnancies in third trimester Measurement of cardiac width (transverse diameter) of the heart was taken. Gestational age was assessed by fetal parameters that are biparietal diameter, femur length and abdominal circumference as per the norms in one of the Mumbai's medical teaching institute and tertiary care center. This study verified that the heart grows very rapidly during the third trimester (positive allometry). The linear increase of the fetal heart shows a strong and significant correlation with the increase of biparietal diameter, femur length and abdominal circumference. Relationships between the cardiac data and fetal age, biparietal diameter, femur length and abdominal circumference were explored by allometry and linear regression analysis in order to estimate cardiac growth rates during third trimester. This suggests that noninvasive analysis of cardiac data can be useful for the assessment of gestational age or for prenatal detection of congenital heart disease.

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Screening for congenital heart disease with the four-chamber view of the fetal heart

Cited by 77 publications

References 6 publications

The results of fetal echocardiography in a tertiary center and comparison of low- and high-risk pregnancies for fetal congenital heart defects

The results of fetal echocardiography in a tertiary center and comparison of low- and high-risk pregnancies for fetal congenital heart defects

Sonographic detection of fetal anomalies of the aortic and pulmonary arteries: value of four-chamber view vs direct images.

Transabdominal Sonographic Quantitative Analysis of the Fetal Cardiac Width in Third Trimester of Gestation

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