Evaluation of Fetal Cardiac Size and Shape: A New Screening Tool to Identify Fetuses at Risk for Tetralogy of Fallot

Abstract

Objective Prenatal detection rates for tetralogy of Fallot (TOF) vary between 23 and 85.7%, in part because of the absence of significant structural abnormalities of the 4‐chamber view (4CV), as well as the relative difficulty in detection of abnormalities during the screening examination of the outflow tracts. The purpose of this study was to evaluate whether the 4CV and ventricles in fetuses with TOF may be characterized by abnormalities of size and shape of these structures. Methods This study retrospectively evaluated 44 fetuses with the postnatal diagnosis of TOF. Measurements were made from the 4CV (end‐diastolic length, width, area, global sphericity index, and cardiac axis) and the right (RV) and left (LV) ventricles (area, length, 24‐segment transverse widths, sphericity index, and RV/LV ratios). Logistic regression analysis was performed to identify variables that might separate fetuses with TOF from normal controls. Results The mean gestational age at the time of the last examination prior to delivery was 28 weeks 5 days (SD 4 weeks, 4 days). The mean z‐scores were significantly lower in fetuses with TOF for the 4CV and RV and LV measurements of size and shape. Logistic regression analysis identified simple linear measurements of the 4CV, RV, and LV that had a sensitivity of 90.9 and specificity of 98.5% that outperformed the 4CV cardiac axis (sensitivity of 22.7%) as a screening tool for TOF. Conclusions Measurements of the 4CV, RV, and LV can be used as an adjunct to the outflow tract screening examination to identify fetuses with TOF.

Feasibility of 4D-Spatio Temporal Image Correlation (STIC) in the Comprehensive Assessment of the Fetal Heart Using FetalHQ®

“…In this context, fetal specific STE software Fetal Heart Quantification (FetalHQ ® ) was recently developed as a promising offline tool that permits the study of global and regional (24-segment) ventricular shape and function [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. Some groups have reported the application of this novel technology to the study of CHD [ 34 , 35 ], and fetal cardiac adaptation to different fetal conditions (fetal growth restriction [ 36 ], diabetes mellitus [ 37 ], twin-to-twin transfusion syndrome [ 38 ]). Despite its potential for further studying the fetal heart, its applicability is limited given the requirement of a high resolution four-chamber view in a specific angle of insonation.…”

Assessment of the Size and Shape of the 4-Chamber View and the Right and Left Ventricles Using Fetal Speckle Tracking in Normal Fetuses at 17–24 Gestational Weeks

“…The DICOM image frame rate was equivalent to the frame rate acquisition at the time of the examination in which the mean frames per cardiac cycle was 49 (standard deviation [SD] 8) or 98 Hz (SD 15). All 4-chamber and speckle tracking measurements were performed by a single examiner (GRD) with expertise in fetal echocardiography and speckle tracking analysis [5-8, 16-18, 28-32].…”

“…Speckle tracking analysis allows physicians to examine many fetal and maternal conditions that alter fetal cardiac function and provides new insights into their pathophysiology. Recently, there have been several studies utilizing fetal speckle tracking to evaluate fetuses with growth restriction [6][7][8][9], twin-to-twin transfusion syndrome [10,11], maternal diabetes [12], and congenital heart disease [13][14][15][16][17][18].…”

Identification of circRNA–miRNA–mRNA Regulatory Network and Crucial Signaling Pathway Axis Involved in Tetralogy of Fallot

“…At present, prenatal diagnosis of TOF mainly relies on fetal echocardiography. The prenatal detection rate of TOF is between 23% and 85.7% ( DeVore et al, 2021 ). Although some indicators can indicate heart malformation in early pregnancy, the diagnosis still needs to be made in the second trimester ( Ren et al, 2019 ; Minnella et al, 2020 ).…”