Anatomical Survey Versus Fetal Echocardiograms for Diagnosis of Cardiac Defects with a Single Umbilical Artery Cases

Abstract

Objective To determine the utility of fetal echocardiography in diagnosing cardiac defects in fetuses with a single umbilical artery (SUA). Methods A retrospective cohort study of prenatally diagnosed SUA was conducted over a 10‐year period at a single institution. Cardiac anatomy on detailed anatomical survey was compared with fetal echocardiogram for fetuses with prenatally diagnosed SUA. A diagnostic meta‐analysis of studies comparing fetal anatomical survey to fetal echocardiogram in fetuses with SUA between 2010 to 2019 was also performed. Results Three hundred and twenty fetuses with SUA were identified, 113 of which had completed both ultrasound and echocardiography. There were 36 cases of cardiac defects on prenatal echocardiogram and all had abnormal anatomical ultrasounds. There were zero cases of abnormal cardiac exams (0%) when the cardiac views on anatomical survey were normal. The sensitivity, specificity, positive predictive value and negative predictive value of ultrasound were 100%, 77%, 73% and 100%, respectively. A summary ROC curve demonstrated a high predictive value of routine anatomic survey for cardiac defects (AUC: 0.99). Conclusion Anatomic survey is highly predictive in the detection of cardiac defects in fetuses with SUA. Fetal echocardiogram is unnecessary in SUA when cardiac views are normal on ultrasound.

Incidence of congenital heart disease in fetuses diagnosed with single isolated umbilical artery. Systematic review and meta‐analysis

“…We found 1384 studies by the search strategy used; after carefully reviewing the full‐text, we finally included 15 studies for analysis (Araujo Júnior et al, 2015; Chen et al, 2014; Chen et al, 2016; DeFigueiredo et al, 2010; Gossett et al, 2002; Gurram et al, 2018; Lee et al, 1998; Miller & Towner, 2019; Prefumo et al, 2010; Sun & Wang, 2018; Tasha et al, 2014; Tonismae et al, 2021; Vasanthalakshmi et al, 2012; Wang et al, 2019; Xin et al, 2014) (Figure 1).…”

“…The incidence of cardiac disease in fetuses with SUA has been described as between 9% and 32% (Araujo Júnior et al, 2015; Friebe‐Hoffmann et al, 2019; Li et al, 2020; Tonismae et al, 2021). In our study, the incidence in fetuses with isolated SUA was 9%, like that reported in the literature.…”

“…The sensitivity and specificity of anatomical ultrasound for detecting congenital heart disease in these fetuses are 100% and 77%, respectively, with a positive predictive value of 73%. Compared with fetal echocardiography, the negative predictive value of ultrasound is 100%, so an echocardiogram is not required in fetuses with SUA and routine anatomical ultrasound (Tai et al, 2021; Tonismae et al, 2021; Wang et al, 2019). The concordance in diagnosing heart disease in fetuses with SUA between maternal‐fetal medicine specialists and pediatric cardiologists is 94%, and diagnostic failures are equal in the two groups (Tasha et al, 2014).…”

“…The incidence of heart disease in fetuses with SAU is between 9% and 32% (Araujo Júnior et al, 2015; Friebe‐Hoffmann et al, 2019; Li et al, 2020; Tai et al, 2021; Tonismae et al, 2021), a study conducted in Norway reported an increased risk of different congenital heart diseases between 2 and 7.6 times in fetuses with SAU (Ebbing et al, 2020). Chen et al found no increased risk of congenital heart disease in fetuses with SAU without other associated risk factors for heart disease (Chen et al, 2016).…”

Machines Do Not Make Diagnoses

“…"The publication continues to justify the false belief that an ultrasound machine makes a diagnosis instead of the correct concept that ultrasound is just a piece of equipment that depends on the observer to make a correct diagnosis. 1 The authors do not seem to realize that "looks" normal versus "is" normal is a concept that depends on many factors including the expertise of the diagnostician. A diagnosis with a stethoscope in the hands of a cardiologist is vastly more valuable than letting a 5-year-old listen to a heart with the same stethoscope.…”