Fetal Cardiac Axis in Fetuses with Conotruncal Anomalies

Abstract

The purpose of this study was to assess the cardiac axis in fetuses with conotruncal anomalies during four-chamber view scanning. We retrospectively evaluated the cardiac axis of 150 fetuses with conotruncal anomalies within the second and third trimester between October 2008 and August 2014. The cardiac axis was obtained by the angle of two lines in a transverse view of the fetal thorax at the level of the four-chamber view. The first line divided the thorax into two equal halves starting from the spine posteriorly ending at the sternum. The second line was placed through the interventricular septum of the fetal heart. The angle was calculated using OsiriX software. 23 had double outlet right ventricle (DORV), 17 had truncus arteriosus communis (TAC), 36 had tetralogy of Fallot (TOF), and 74 had complete transposition of the great arteries (d-TGA). In fetuses with DORV ≤ 24 + 6 weeks of gestation (wks), the mean cardiac axis was 52.5° (p = 0.005), at ≥ 25 + 0 wks it was 51.1° (p = 0.0003). In fetuses with TAC ≤ 24 + 6 wks, the mean cardiac axis was 56.8° (p = 0.01), at ≥ 25 + 0 wks it was 50.0° (p = 0.05). In fetuses with TOF ≤ 24 + 6 wks, the mean cardiac axis was 67.5° (p < 0.0001), at ≥ 25 + 0 wks it was 63.8° (p < 0.0001). In fetuses with d-TGA ≤ 24 + 6 wks, the mean cardiac axis was 45.6°, at ≥ 25 + 0 wks it was 45.4° (not significant). Throughout gestation, the cardiac axis did not show a difference in the two separate examinations. In fetuses with DORV, TAC and TOF, the cardiac axis is significantly different from the normal axis, but in fetuses with TGA there is no significant difference compared to the normal axis. Therefore, analysis of the heart axis could be useful for screening for conotruncal anomalies.

Outcome and Associated Findings in Individuals with Pre- and Postnatal Diagnosis of Tetralogy of Fallot (TOF) and Prediction of Early Postnatal Intervention

“…However, this might hold true, as primary detection of congenital cardiac anomalies is poor according to the German screening program "Mutterschaftsrichtlinien", especially for conotruncal anomalies which might not be easily detectable within the 4-chamber view. But with more training for the basic examiner, we showed before that careful evaluation of the fetal cardiac axis at 18-22 wks could be a useful screening tool for better prenatal detection of conotruncal anomalies like TOF, because of the frequent leftward rotation of the cardiac axis in those cases [15].…”

Semi-Automatic Measurement of Fetal Cardiac Axis in Fetuses with Congenital Heart Disease (CHD) with Fetal Intelligent Navigation Echocardiography (FINE)

“…An abnormal fetal cardiac axis can point towards CHD and promote an early diagnosis [40][41][42][43]. A recent analysis was able to demonstrate that the cardiac axis is significantly different from the normal axis in conotruncal anomalies (DORV, TAC, and TOF) [45]. Additionally, the study showed that in…”

Increased Pulmonary-Aortic Interspace in Fetal Right Aortic Arch: A Matched Case-Control Study

“…Initial measurements were used in all analyses. Finally, the heart axis was measured in the four-chamber view as described in the ISUOG guidelines [ 25 ], as other studies showed an abnormal heart axis can be associated with an RAA [ 26 , 27 ].…”