Fetal Cardiac Axis and Congenital Heart Defects in Early Gestation

Sinkovskaya, Elena; Chaoui, Rabih; Karl, K.; Андреева, Елена; Zhuchenko, Ludmila; Abuhamad, Alfred

doi:10.1097/aog.0000000000000608

Cited by 52 publications

(43 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is lower than the 26.4% reported by Syngelaki et al [2] and the 56% reported by Grande et al [3], but higher than in other previous studies [9,10]. In a protocol for first-trimester detection of anomalies, the use of a combination of markers such as NT, ductus venosus flow, tricuspid regurgitation, and measurement of the cardiac axis has the potential of significantly increasing detection rates [11][12][13].…”

Section: Discussioncontrasting

confidence: 54%

Early Detection of Structural Anomalies in a Primary Care Setting in the Netherlands

Bardi

Smith²,

Kuilman³

et al. 2018

Fetal Diagn Ther

View full text Add to dashboard Cite

Objective: This study assessed the percentage and type of congenital anomalies diagnosed at first-trimester ultrasound (US) scan in a primary care setting without following a standardized protocol for fetal anatomical assessment. Materials and Methods: US scans performed between 11⁺⁰ and 13⁺⁶ weeks of gestation in pregnancies with estimated date of delivery between January 1, 2012 and January 1, 2016 were searched. Data were supplemented with results of 20-week scans and pregnancy outcome. Results: Of all scans, 38.6% were dating scans and 61.4% were part of first-trimester screening. Anomalies were diagnosed prenatally in 200 (1.8%) fetuses; 81 (0.7%) were chromosomal and 119 (1.1%) were structural. Of all prenatally detected anomalies, 27% (n = 32) were detected at first-trimester scan, with a false-positive rate of 0.04%. All cases of anencephaly (n = 4), encephalocele (n = 2), exomphalos (n = 9), megacystis (n = 4), and limb reduction (n = 1) were diagnosed. First-trimester detection of gastroschisis and congenital heart defects was 67 and 19%, respectively. Conclusion: In a primary care setting, global fetal anatomical assessment at first-trimester scan without following a standardized protocol detects about 30% of all structural anomalies and most of the severe anomalies, with an extremely low false-positive rate. We hypothesize that additional training and use of a systematic protocol would improve early detection of structural anomalies.

show abstract

Section: Discussioncontrasting

confidence: 54%

Early Detection of Structural Anomalies in a Primary Care Setting in the Netherlands

Bardi

Smith²,

Kuilman³

et al. 2018

Fetal Diagn Ther

View full text Add to dashboard Cite

show abstract

“…A recent review of the published series with more than 1,000 cases from 1993 to 2008, which included data from 36,237 pregnancies generated by eight centers, suggests that the overall detection rate of major CHD at 11-13 weeks is 29% (95% CI 25-33) [6] . The pooled detection rate of cardiac defects was 17% (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). The authors suggested that the detection rate could be improved if the first-trimester ultrasound assessment followed very well-delineated protocols [31] .…”

Section: Clinical and Research Implicationsmentioning

confidence: 93%

“…Furthermore, normal tricuspid blood flow is a significant protective marker (LH-= 0.4). It has been widely demonstrated that first-trimester indirect signs, including NT, TR, ductus venosus (DV), and abnormal cardiac axis, are significantly associated with the risk of CHD [24,25] . The underlying mechanism of this association is uncertain.…”

Section: Interpretation Of the Findingsmentioning

confidence: 99%

Fetal Tricuspid Regurgitation in the First Trimester as a Screening Marker for Congenital Heart Defects: Systematic Review and Meta-Analysis

Scala¹,

Morlando²,

Familiari³

et al. 2017

Fetal Diagn Ther

View full text Add to dashboard Cite

Background: Assessment of tricuspid flow has been reported to improve the performance of screening for aneuploidies and congenital heart defects (CHD). However, the performance of tricuspid regurgitation (TR) as a screening marker for CHD in euploid fetuses is yet to be established. The main aim of this meta-analysis was to establish the predictive accuracy of TR for CHD. Methods: MEDLINE, Embase, and the Cochrane Library were searched electronically utilizing combinations of the relevant medical subject heading for “fetus,” “tricuspid regurgitation,” and “first trimester.” The outcomes explored were prevalence of TR in an euploid population, strength of association between TR and CHD, and predictive accuracy of TR for CHD in euploid fetuses. Summary estimates of sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio for the overall predictive accuracy of TR for the detection of CHD were computed using the hierarchical summary receiver-operating characteristics model. Results: A total of 452 articles were identified; 60 were assessed with respect to their eligibility for inclusion and a total of 4 studies were included in the study. TR was associated with an increased risk of CHD (RR: 9.6, 95% CI 2.8-33.5; I²: 92.7%). The strength of association between TR and CHD persisted when considering fetuses at risk for CHD, such as those with increased nuchal translucency (RR: 7.2, 95% CI 5.2-9.8; I²: 0%), while TR did not show any association with CHD when detected in a population at low risk for cardiac defects (RR: 9.3, 95% CI 0.8-111.8; I²: 93%). The overall diagnostic performance of TR in detecting CHD was poor in detecting CHD (sROC: 0.684, SE: 0.61) with a sensitivity of 35.2% (95% CI 26.9-44.1) and a specificity of 98.6% (95% CI 98.5-98.7). Detection of TR at the 11-14 weeks' scan showed a positive likelihood ratio of 7.2 (95% CI 5.3-9.8) in detecting CHD when applied to a population at risk for CHD such as fetuses with an increased nuchal translucency. Conclusion: The detection of TR in the first trimester increases the risk of CHD. However, isolated TR in the first trimester does not seem to be a strong predictor for CHD.

show abstract

“…Sinkovskaya et al [30] reported a normal variation in the cardiac axis from 34.5° at 11 weeks to 56.8° at 13 + 6 weeks of gestation, and that an abnormal cardiac axis can be associated with coarctation of the aorta, Ebstein's anomaly, transposition of the great vessels, and heterotaxy. The same group reported that 74.1% of fetuses with confirmed CHD had an abnormal cardiac axis when evaluated between 11 and 13 + 6 weeks/days of gestation [31] . In their study, the cardiac axis performed better than increased nuchal translucency, tricuspid regurgitation, or reversed atrial waveform in the ductus venosus in detecting major fetal cardiac defects.…”

Section: Ultrasound Findings Suggestive Of Fetal Cardiac Anomaliesmentioning

confidence: 95%

Early Evaluation of the Fetal Heart

et al. 2017

View full text Add to dashboard Cite

Evaluation of the fetal heart at 11-13 + 6 weeks of gestation is indicated for women with a family history of congenital heart defects (CHD), a previous child with CDH, or an ultrasound finding associated with cardiac anomalies. The accuracy for early detection of CHD is highly related to the experience of the operator. The 4-chamber view and outflow tracts are the most important planes for identification of an abnormal heart, and can be obtained in the majority of fetuses from 11 weeks of gestation onward. Transvaginal ultrasound is the preferred route for fetal cardiac examination prior to 12 weeks of gestation, whereas, after 12 weeks, the fetal heart can be reliably evaluated by transabdominal ultrasound. Cardiac defects, such as ventricular septal defects, tetralogy of Fallot, Ebstein's anomaly, or cardiac tumors, are unlikely to be identified at ≤14 weeks of gestation. Additional ultrasound techniques such as spatiotemporal image correlation and the evaluation of volumes by a fetal-heart expert can improve the detection of congenital heart disease. The evaluation of the fetal cardiac function at 11-13 + 6 weeks of gestation can be useful for early identification of fetuses at risk of anemia due to hemoglobinopathies, such as hemoglobin Bart's disease.

show abstract

Fetal Cardiac Axis and Congenital Heart Defects in Early Gestation

Abstract: Abnormal cardiac axis is present in two-thirds of fetuses with congenital heart defect in early gestation. Adding cardiac axis assessment to the nuchal translucency measurement is helpful in defining a population at risk for fetal congenital heart defect.

Cited by 52 publications

References 17 publications

Early Detection of Structural Anomalies in a Primary Care Setting in the Netherlands

Early Detection of Structural Anomalies in a Primary Care Setting in the Netherlands

Fetal Tricuspid Regurgitation in the First Trimester as a Screening Marker for Congenital Heart Defects: Systematic Review and Meta-Analysis

Early Evaluation of the Fetal Heart

Contact Info

Product

Resources

About