Fetal cardiac evaluation at 11–14 weeks by experienced obstetricians in a low‐risk population

Volpe, P.; Passamonti, Ubaldo; Volpe, N.; Campobasso, G.; Robertis, V. De; Tempesta, A.; Volpe, G.; Rembouskos, G.

doi:10.1002/pd.2831

Cited by 64 publications

(85 citation statements)

References 28 publications

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“…15 Similarly, Perisco et al 16 showed a 93.1% detection rate for congenital heart defects in a group of 886 patients including 100 cardiac anomalies. Also, Volpe et al 17 demonstrated that the direct assessment of the heart at 11 to 14 weeks is a feasible method of screening for congenital heart defects in an unselected population. Direct assessment of the fetal heart in the first trimester to search for congenital heart defects in a high-risk population revealed that the examiner's experience and the selection of patients are among the most important factors that have an impact on detection of congenital heart defects.…”

Section: Discussionmentioning

confidence: 99%

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%

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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“…Tables 1 and 2 summarizes some of the largest and most significant studies on the detection of CHD using early fetal echocardiography in high-risk and low-risk pregnancies. 14,[17][18][19][20][21][22][24][25][26][34][35][36][37][38][39][40][41][42][43][44][45][46] Obviously, studies in unselected population report less encouraging results, with lower visualization rates and detection rates. The largest series was published by Bronshtein et al 20 They report the diagnosis of 173 cases of CHD over 36,323 fetuses evaluated by transvaginal ultrasound at 11 to 17 weeks' gestation over a 14-year period of time, with 99% of scans performed at 14 to 16 weeks' gestation and 86% of them in low-risk population.…”

Section: Diagnosis Of Chdmentioning

confidence: 99%

Echocardiography in Early Pregnancy

Comas¹,

RodrRguez²

2013

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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Within the last decade, two significant events have contributed to the increasing interest in early fetal echocardiography. First, the introduction of high frequency vaginal ultrasound probes allows detailed visualization of cardiac structures at early stage of gestation, making early detection of fetal malformations possible. Second, the close relationship observed between some first trimester sonographic and Doppler markers and congenital heart defects allows an early identification of a high-risk group at 11 to 14 weeks of gestation. In this context, from the early 1990s, many authors have examined the potential role of the transvaginal approach to obtain earlier diagnosis of fetal cardiac malformations. Further studies have appeared in the literature showing that early transvaginal echocardiography in experienced hand is a fairly sensitive investigative tool. Although some malformations are detected as early as 11 weeks' gestation, the optimal gestational age to perform the early scan is at least 13 weeks' gestation. Transvaginal ultrasound is the preferred approach, although most of the authors agree that results can be improved if transabdominal ultrasound is also incorporated. The further application of color Doppler enhances visualization. The sensitivity and specificity of early fetal echocardiography for the detection of heart anomalies is acceptable compared to the ones obtained by mid-gestational echocardiography, showing a slight reduction in detection rates and an increase in false positive and negative rates. The cardiac anomalies detected at this early stage of pregnancy are mainly defects involving the four-chamber view, indicating that defects solely affecting the outflow tracts are difficult to diagnose in the first trimester of pregnancy. Heart defects diagnosed early in pregnancy tend to be more complex than those detected later, with a higher incidence of associated structural malformations, chromosomal abnormalities and spontaneous abortions. The neonate follow-up or postmortem examination in case of termination of pregnancy (TOP) is essential to assess the actual role of early fetal echocardiography. At present, early fetal echocardiography is a promising technique, which can be of considerable value for patients at high-risk. This technique is, however, currently limited to a few specialized centers.The aim of this review is to explore the possibilities of examining the fetal heart at this early stage of pregnancy. This article also present our experience in the first multicenter trial in early fetal echocardiography performed in Spain. In accordance with other studies, this experience stresses the usefulness of early echocardiography when performed by expert operators on fetus specifically at risk for cardiac defects. Our review of these additional 48 cases contributes to the expanding literature on the ability of transvaginal ultrasonography to detect fetal heart defects in early pregnancy.

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“…Die Arbeitsgruppe aus Bari veröffentlichte zwei Arbeiten, in denen sie an einem High-riskKollektiv [29] und an einem Lowrisk-Kollektiv [47] …”

Section: Transiente Hinweiszeichenunclassified

Update Pränataldiagnostik

2014

Gynäkologe

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Die im ersten und frühen zweiten Trimester stark schwankende Entdeckungsrate für isolierte Herzfehler ist wegen der großen Schwierigkeit einer umfassenden Untersuchung dieses Organs extrem von verschiedensten Faktoren abhängig.Herzfehler -Screening und Diagnostik im ersten und frühen zweiten Trimenon 728 | Der Gynäkologe 10 · 2014 © U. Gembruch 8 a Atrioventrikulärer Septumdefekt (AVSD) bei einem Feten mit Linksisomerismus in 12+5 SSW. b Bei der Farbdoppleruntersuchung zeigt sich der diastolische Einfluss über die gemeinsame AV-Klappe in beide Herzkammern (rot kodiert).

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Fetal cardiac evaluation at 11–14 weeks by experienced obstetricians in a low‐risk population

Abstract: First-trimester assessment of the fetal heart is feasible in a low-risk population when performed by experienced obstetricians. However, although most types of CHD can be diagnosed early in pregnancy, some may become apparent later in gestation.

Cited by 64 publications

References 28 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

Echocardiography in Early Pregnancy

Update Pränataldiagnostik

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