Applicability and technical aspects of two-dimensional ultrasonography for assessment of fetal heart function

Abstract

In recent years, fetal echocardiography has been used for the screening and diagnosis of anatomical heart defects and for the detailed study of fetal cardiac function. This method is characterized by its easy implementation and good reproducibility, allowing the diagnosis of myocardial dysfunction even in its subclinical phase. The functional assessment of the fetal heart should be routinely performed in fetuses with congenital heart disease and those without anatomical malformation. Several extra-cardiac conditions may alter fetal cardiac function, by increased placental resistance, volume overload or hyperdynamic circulation, compression, or maternal systemic disease with involvement of the fetal myocardium. This review addresses the main ultrasound techniques and various Doppler echocardiographic parameters available for the analysis of fetal heart function, and correlates them with clinical applicability. Various parameters available for the assessment of fetal myocardium, including those that evaluate atrial dynamics, can be used in this analysis and should be selected considering specific conditions.

Evaluation of right ventricular volume and systolic function in normal fetuses using intelligent spatiotemporal image correlation

“…Accurate assessment of fetal cardiac function could help to understand the process of fetal heart disease, improve the accuracy of diagnosis, and determine prenatal interventions[2,5,6,16,19,20,22,23,26,30-39]. Two-dimensional ultrasound is still the traditional gold standard for diagnosis of fetal congenital heart diseases[17,20,21] but has a number of limitations in the quantitative evaluation of fetal ventricular volume and cardiac function. When abnormal fetal heart structure causes significant cardiac geometric morphology changes, accurate quantitative assessment of fetal ventricular volume and cardiac function by 2D ultrasound is difficult[3,34].…”

“…Application of the STIC imaging technique in fetal heart disorders has been studied extensively, which adds the time factor into the process of 3D data acquisition with continuous unidirectional scanning of the target area by the sensor to obtain the 3D volume data composed of each 2D slice. After completion of volume data acquisition, the software can automatically group 2D sections at the same time to reorganize the image of the entire fetal cardiac cycle, with end-systolic and end-diastolic phases of the cardiac cycle image defined according to opening and closing of the atrioven-tricular valve in post-processing[3,16,17,20-23,29,36,38-42]. Such technology overcomes the imaginary heart geometry by 2D ultrasound along with a relatively simple image acquisition process and fewer requirements for operator experience.…”

Diagnostic value of echocardiography in fetal cardiac malformation and clinical classification

“…There are many reasons for cardiac malformation, such as chromosomal abnormality and heredity, and with the advancement of society and the development of modern industry, the exposure of pregnant women to chemicals and radiation during gestation period is higher than before, which also leads to the increase of the morbidity of fetal cardiac malformation (12–14). In general, the condition of cardiac malformation of fetuses can only be detected by ultrasound before birth, because ultrasound is a safe, rapid and effective examination method (15). Fetuses with cardiac malformation often have some symptoms after birth, such as lung infection, slow growth, and cardiac murmur, which has a great impact on living quality of children, therefore, the detection of cardiac malformation is particularly important for fetuses (16).…”

Functional cardiac measurements performed by two-dimensional Doppler echocardiography in normal fetuses: Determination of Z-scores and future prospects

“…[2425] Therefore, potential clinical applications for pulmonary vein Doppler are conditions with possible increase of left atrial pressure, such as fetuses of diabetic pregnant women with myocardial hypertrophy, fetuses with hypoplastic left heart syndrome, and in fetal growth restriction. [2627] Accordingly, the knowledge of normal reference values of the velocities of the waves of the pulmonary venous waves and its pattern is fundamental.…”