Contribution of Fetal Tricuspid Regurgitation in First-Trimester Screening for Major Cardiac Defects

Pereira, Susana; Ganapathy, Ramesh; Syngelaki, Argyro; Maíz, Nerea; Nicolaides, Kypros H.

doi:10.1097/aog.0b013e31821aa720

Cited by 108 publications

(123 citation statements)

References 31 publications

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“…1,4,13,14 To our knowledge, this article is the first practical description of a straightforward and direct screening method for congenital heart defects in the first trimester. In this study we found that our simple firsttrimester cardiac protocol was an effective screening method for congenital heart defects.…”

Section: Discussionmentioning

confidence: 99%

“…They were based on markers of aneuploidy, including nuchal translucency, triuspid regurgitation, and ductus venosus velocimetric parameters. [1][2][3][4] However, the detection rates for congenital heart defects do not exceed 40% for nuchal translucency above the 95th percentile alone and 58% for nuchal translucency above the same limit combined with a reversed or absent a-wave in the ductus venosus flow profile. 1 Objectives-The first goal of this study was to analyze the diagnostic performance of the 4-chamber view, 3-vessel and trachea view, and their combination in color mapping during early cardiac evaluations for selecting cases suspicious of congenital heart defects.…”

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confidence: 98%

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Prenatal Detection of Congenital Heart Defects at the 11‐ to 13‐Week Scan Using a Simple Color Doppler Protocol Including the 4‐Chamber and 3‐Vessel and Trachea Views

Wiechec

Knafel

Nocun

2015

J of Ultrasound Medicine

104

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n the past years, plenty of reports about indirect screening methods for the diagnosis of congenital heart defects were published. They were based on markers of aneuploidy, including nuchal translucency, triuspid regurgitation, and ductus venosus velocimetric parameters. [1][2][3][4] However, the detection rates for congenital heart defects do not exceed 40% for nuchal translucency above the 95th percentile alone and 58% for nuchal translucency above the same limit combined with a reversed or absent a-wave in the ductus venosus flow profile. 1 Objectives-The first goal of this study was to analyze the diagnostic performance of the 4-chamber view, 3-vessel and trachea view, and their combination in color mapping during early cardiac evaluations for selecting cases suspicious of congenital heart defects. The second goal was to describe the most common abnormal flow patterns at the levels of the 4-chamber and 3-vessel and trachea views in the late first trimester.Methods-We conducted a prospective observational study in which a simple cardiac sonographic protocol was applied in fetuses at gestational ages of 11 weeks to 13 weeks 6 days.Results-A total of 1084 patients with known postnatal or autopsy findings were included in the study. The median maternal age was 32.3 years (range, 27-40 years). The median crown-rump length was 62.2 mm (range, 45-84 mm). Overall, there were 35 cases with a confirmed congenital heart defect (3.22%), including 16 accompanied by aneuploidy. We found that our simple first-trimester cardiac protocol was an effective screening method for congenital heart defects. The most effective approach of the 3 evaluated by us was the combined application of the 4-chamber and 3-vessel and trachea views in color mapping compared to the 4-chamber and 3-vessel and trachea views alone. We defined the most common ventricular inflow patterns and the V sign. The technique we used was simple and easy to reproduce.Conclusions-We confirmed that evaluation by two basic cardiac views allows for selection of most cases with a univentricular heart, atrioventricular septal defects, coarctation of the aorta, pulmonary stenosis, pulmonary atresia, and conotruncal defects.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 98%

Prenatal Detection of Congenital Heart Defects at the 11‐ to 13‐Week Scan Using a Simple Color Doppler Protocol Including the 4‐Chamber and 3‐Vessel and Trachea Views

Wiechec

Knafel

Nocun

2015

J of Ultrasound Medicine

104

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“…For example, cardiac function assessment has proven utility in the differential diagnosis of cardiomyopathies 60 or prediction of perinatal mortality in congenital heart disease 61 . Similarly, first‐trimester DV and tricuspid regurgitation assessment has an additional predictive value for Down syndrome and congenital heart disease 62 . In addition, some cardiac parameters with high sensitivity such as MPI or annular peak velocities have shown promising results in monitoring and predicting outcome in intrauterine growth restriction 9 , 58 or congenital diaphragmatic hernia 5 .…”

Section: Discussionmentioning

confidence: 99%

Ultrasound assessment of fetal cardiac function

Crispi

Valenzuela-Alcaráz

Cruz‐Lemini

et al. 2013

Australas J Ultrason Med

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Introduction: Fetal heart evaluation with US is feasible and reproducible, although challenging due to the smallness of the heart, the high heart rate and limited access to the fetus. However, some cardiac parameters have already shown a strong correlation with outcomes and may soon be incorporated into clinical practice. Materials and Methods: Cardiac function assessment has proven utility in the differential diagnosis of cardiomyopathies or prediction of perinatal mortality in congenital heart disease. In addition, some cardiac parameters with high sensitivity such as MPI or annular peak velocities have shown promising results in monitoring and predicting outcome in intrauterine growth restriction or congenital diaphragmatic hernia. Conclusion: Cardiac function can be adequately evaluated in most fetuses when appropriate expertise, equipment and time are available. Fetal cardiac function assessment is a promising tool that may soon be incorporated into clinical practice to diagnose, monitor or predict outcome in some fetal conditions. Thus, more research is warranted to further define specific protocols for each fetal condition that may affect cardiac function.

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“…In view of the low detection rates for certain abnormalities -particularly for cardiac defectsin the 2nd trimester, the use of surrogate markers for abnormalities detectable in the 1st trimester should not become less important [15]. A study which included approximately 40 000 normal pregnancies and 85 foetuses with serious cardiac defects showed that combining the assessment of nuchal translucency with that of blood flow in the ductus venosus and through the tricuspid valve in the 12+ week of gestation resulted in the detection of around 60 % of all cardiac defects [16]. It has also been shown that the risk for numerous pregnancy complications can be assessed around 12+ weeks of gestation.…”

Section: Studymentioning

confidence: 99%

Assessment of Foetal DNA in Maternal Blood – A Useful Tool in the Hands of Prenatal Specialists

Kagan

Hoopmann

Kozlowski³

2012

Geburtsh Frauenheilk

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Introduction !In the last few years, first trimester screening (FTS) in 11+ to 13+ weeks of gestation (12th to 14th weeks of gestation) has become one of the most important ultrasound examinations in pregnancy, as it allows physicians to predict several pregnancy complications [1]. While, initially, the main focus was to determine the personal risk for trisomies 21, 18 and 13, today around half of all severe foetal defects can be recognised at the time of FTS. In addition, the risks for pre-eclampsia, growth retardation and pre-term birth can be determined. Various interventions and therapies are now available to treat many of these problems in patients considered at particular risk [2,38]. The use of foetal DNA obtained from maternal blood and massively parallel sequencing has made it possible to detect foetal trisomy 21 with a high degree of probability already in the first trimester of pregnancy [3]. At a casual glance it would appear that use of foetal DNA to assess the risk for trisomy 21 now competes with FTS. But on more careful examination of these tests it becomes clear that assessment of foetal DNA has the potential to become an important tool for prenatal medicine specialists in future. This review offers an assessment of foetal DNA analysis in the context of current prenatal medical questions and demonstrates the practical uses of this approach. Assessment of Free Foetal DNA from Maternal Blood !The detection of foetal DNA in maternal blood or, to be more precise, in cell-free maternal plasma goes back to a study by Lo et al. published in 1997 [4]. Pregnancy-specific cell-free DNA in maternal blood or plasma constitutes around 10 % of all cell-free DNA, is largely fragmented and is not Abstract ! Over the last few years, first trimester screening between 11+ and 13+ weeks of gestation has become one of the most important ultrasound examinations in pregnancy, as it allows physicians to predict several pregnancy complications including pre-eclampsia or pre-term birth. Screening for trisomies 21/18 and 13 using maternal and gestational age, foetal nuchal translucency, and maternal serum biochemistry was formerly the main reason for first trimester screening. However, today this is only one part of the overall examination. In the near future, the analysis of foetal DNA obtained from maternal blood will be used to supplement first trimester screening for aneuploidy or even replace current screening methods. In this review we show how prenatal medicine specialists can use foetal DNA analysis. Zusammenfassung !Das Ersttrimesterscreening in der 11 + bis 13 + SSW hat sich in den vergangenen Jahren zu einer der zentralen Ultraschalluntersuchungen in der Schwangerschaft entwickelt, welche die Prädik-tion zahlreicher Probleme in der Schwangerschaft, wie Präeklampsie oder Frühgeburtlichkeit, erlaubt. Die eigentliche Risikoberechnung für Trisomie 21/18 und 13, basierend auf dem mütter-lichen Altersrisiko, der fetalen Nackentransparenz und der maternalen Serumbiochemie, stellt dabei nur einen der Schwerpunkte dar,...

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Contribution of Fetal Tricuspid Regurgitation in First-Trimester Screening for Major Cardiac Defects

Abstract: Assessment of flow across the tricuspid valve improves the performance of screening for major cardiac defects by fetal nuchal translucency and ductus venosus flow.

Cited by 108 publications

References 31 publications

Prenatal Detection of Congenital Heart Defects at the 11‐ to 13‐Week Scan Using a Simple Color Doppler Protocol Including the 4‐Chamber and 3‐Vessel and Trachea Views

Prenatal Detection of Congenital Heart Defects at the 11‐ to 13‐Week Scan Using a Simple Color Doppler Protocol Including the 4‐Chamber and 3‐Vessel and Trachea Views

Ultrasound assessment of fetal cardiac function

Assessment of Foetal DNA in Maternal Blood – A Useful Tool in the Hands of Prenatal Specialists

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