Utility of Fetal Echocardiography After Normal Cardiac Imaging Findings on Detailed Fetal Anatomic Ultrasonography

Starikov, Roman; Bsat, Fadi; Knee, Alexander; Tsirka, Anna E.; Paris, Yvonne; Markenson, Glenn

doi:10.7863/jum.2009.28.5.603

Cited by 14 publications

(17 citation statements)

References 17 publications

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“…However, it cannot be overlooked that when Complete cardiac structures are confirmed normal, 50% of those concerning on echocardiogram were false positives with only one of the 10 considered critical. These findings mimic prior studies that demonstrated not only a low detection rate for major CHD on screening fetal echocardiogram with an unremarkable detailed ultrasound, but also a not insignificant false positive rate on echocardiograms . When combining our dataset with those previously reported, only five major/critical CHDs were discovered despite 4237 screening ultrasounds for a detection rate of 0.12% (95% CI, 0.01%‐0.22%) .…”

Section: Discussionsupporting

confidence: 88%

“…Prior to the universal recommendation of implementing views of the outflow tracts, some advocated for universal fetal echocardiography screening due it its high sensitivity for the detection of CHD . However, since the inclusion of the outflow tracts into the detailed ultrasound, some question the role of screening fetal echocardiogram in the presence of a normal cardiac exam on a detailed ultrasound . Although fetal echocardiography improves detection rates over routine anatomical screening, it is technically demanding and expensive .…”

Section: Introductionmentioning

confidence: 99%

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The added value of screening fetal echocardiography after normal cardiac views on a detailed ultrasound

et al. 2019

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Objective Evaluate fetal echocardiography's ability to detect critical (lesions requiring immediate neonatal intensive care) congenital heart disease (CHD) after normal anatomic cardiac views on detailed ultrasound. Methods Singletons with both a detailed ultrasound at 18 + 0 to 22 + 6 weeks and echocardiogram performed at least 14 days later and at 20 + 0 to 24 + 6 weeks. Cases with cardiac pathology on detailed ultrasound were excluded. Different combinations of cardiac views were described: Basic (four‐chamber, outflow tracts), Expanded (plus three‐vessel view), and Complete (plus ductal/aortic arches). “Normal” was defined on either 2D gray scale or color Doppler. Primary outcome was rates of critical CHD missed on ultrasound but seen on fetal echocardiogram. Results One thousand two hundred twenty‐three women had normal Basic cardiac views. One thousand one hundred ninety (97.3%) were confirmed normal on echocardiogram. Twenty‐one (1.71%) total CHDs were missed, and three were critical (0.25%; 95% CI, 0.03%‐0.53%). Of the 1,223 women, 763 had Complete views. Ten (1.31%) total CHDs were missed and one (0.13%; 95% CI, 0.13%‐0.36%) was confirmed critical. Conclusion Fetal echocardiography can increase CHD detection despite normal cardiac anatomy on detailed ultrasound; however, CHDs missed are rarely critical. Approximately 750 fetal echocardiograms need to be performed to detect one critical CHD with Complete normal cardiac views on detailed ultrasound.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

The added value of screening fetal echocardiography after normal cardiac views on a detailed ultrasound

et al. 2019

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“…145,147 In low-and high-risk populations evaluated in university settings in the recent era, anatomic survey that included the 4-chamber view and outflow tracts minimized the need for detailed fetal echocardiogram. 148 It stands to reason that with uniform standards for training and performance, detection rates may improve, 144 with fetal echocardiography being reserved for those expectant women in whom obstetric scanning suggests the possibility of an abnormality.…”

Section: Obstetric Screeningmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

979

543

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Background— The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. Methods and Results— A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin–twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. Conclusions— Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.

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“…The fetal echocardiographic examinations were performed by an experienced fetal medicine consultant or by a fetal cardiologist. Recent reports have shown that fetal echocardiography may be of limited benefit after normal anatomy scan results have been obtained at an institution where a high volume of sonographic examinations are performed or where the examinations are read by maternal‐fetal medicine specialists …”

Section: Discussionmentioning

confidence: 99%

Isolated Single Umbilical Artery and Fetal Echocardiography: A 25‐Year Experience at a Tertiary Care City Hospital

Gurram

Figueroa

Sipusic

et al. 2017

J of Ultrasound Medicine

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Utility of Fetal Echocardiography After Normal Cardiac Imaging Findings on Detailed Fetal Anatomic Ultrasonography

Cited by 14 publications

References 17 publications

The added value of screening fetal echocardiography after normal cardiac views on a detailed ultrasound

The added value of screening fetal echocardiography after normal cardiac views on a detailed ultrasound

Diagnosis and Treatment of Fetal Cardiac Disease

Isolated Single Umbilical Artery and Fetal Echocardiography: A 25‐Year Experience at a Tertiary Care City Hospital

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