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Objective Fetal echocardiography (FE) provides detailed information about cardiac structure and function in-utero. Limited information is available regarding normal findings late in pregnancy. We therefore sought to identify and describe common cardiac findings in late gestation. Methods Fetuses with structurally normal hearts were identified in mid-gestation within a subset of pregnant women in a prospective study. Atrioventricular valves (AV), right and left atrium (RA/LA), aortic isthmus (AoI) and ductus arteriosus (DA) dimensions and flow abnormalities, aneurysm of septum primum, and presence/grade of tricuspid regurgitation (TR) were assessed throughout pregnancy. Linear and logistic regression analyses were used to characterize change in quantitative and qualitative FE parameters by gestational age. Results 40 fetuses between 24 and 38 weeks gestational age (GA) were studied. Each had a FE study completed before and after 34 weeks gestation that were compared. Tricuspid/mitral valve and RA/LA ratios increased with GA (p<0.001). More frequently noted after 34 weeks GA were tapering of the DA (2.5% vs. 32%), prominent AoI diastolic flow (5% vs. 67%), prominent DA diastolic flow (2.5% vs. 25%), trivial/mild TR (35% vs. 80%), and aneurysm of septum primum (37% vs 80%). These findings all increased linearly with GA (p<0.001). Conclusion AV valve and RA/LA disproportion, mild DA tapering, prominent AoI and DA diastolic flow, trivial/mild TR, and aneurysm of septum primum are frequently identified after 34 weeks GA. This suggests that these FE findings in isolation are likely normal and are a result of the physiologic alterations that occur late in the third trimester.

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Left ventricular hypertrophy (LVH) is a common finding on pediatric electrocardiography (ECG) leading to many referrals for echocardiography (echo). This study utilizes a novel analytics tool that combines ECG and echo databases to evaluate ECG as a screening tool for LVH. SQL Server 2012 data warehouse incorporated ECG and echo databases for all patients from a single institution from 2006 to 2016. Customized queries identified patients 0-18 years old with LVH on ECG and an echo performed within 24 h. Using data visualization (Tableau) and analytic (Stata 14) software, ECG and echo findings were compared. Of 437,699 encounters, 4637 met inclusion criteria. ECG had high sensitivity (≥ 90%) but poor specificity (43%), and low positive predictive value (< 20%) for echo abnormalities. ECG performed only 11-22% better than chance (AROC = 0.50). 83% of subjects with LVH on ECG had normal left ventricle (LV) structure and size on echo. African-Americans with LVH were least likely to have an abnormal echo. There was a low correlation between VR on ECG and echo-derived Z score of left ventricle diastolic diameter (r = 0.14) and LV mass index (r = 0.24). The data analytics client was able to mine a database of ECG and echo reports, comparing LVH by ECG and LV measurements and qualitative findings by echo, identifying an abnormal LV by echo in only 17% of cases with LVH on ECG. This novel tool is useful for rapid data mining for both clinical and research endeavors.

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