Guidelines and Recommendations for Performance of the Fetal Echocardiogram: An Update from the American Society of Echocardiography

Moon-Grady, Anita J.; Donofrio, Mary T.; Gelehrter, Sarah; Hornberger, Lisa K.; Kreeger, Joe; Lee, Wesley; Michelfelder, Erik C.; Morris, Shaine A.; Peyvandi, Shabnam; Pinto, Nelangi M.; Pruetz, Jay D.; Sethi, Neeta; Simpson, John; Srivastava, Shubhika; Tian, Zhenjun

doi:10.1016/j.echo.2023.04.014

Cited by 56 publications

(29 citation statements)

References 136 publications

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“…In light of the above, sonographers must manually segment structures such as the spine, septum, ribs, and thorax when measuring CAx and CRT prenatally [ 3 , 4 ]. Identifying these boundaries can be challenging for novices.…”

Section: Discussionmentioning

confidence: 99%

“…The four-chamber view is one of the most important in fetal echocardiography, providing valuable information for the detection of congenital heart defects (CHDs) [ 2 ]. Current guidelines recommend the use of the fetal cardiac axis (CAx) and cardiothoracic ratio (CTR) as key metrics for evaluating cardiac position and function [ 3 , 4 ]. The CAx is determined by drawing a line from the spine to the anterior chest wall, bisecting the thorax into symmetrical right and left sections, and drawing another line along the interventricular septum.…”

Section: Introductionmentioning

confidence: 99%

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Automatic segmentation of 15 critical anatomical labels and measurements of cardiac axis and cardiothoracic ratio in fetal four chambers using nnU-NetV2

Liang,

Peng,

Luo

et al. 2024

BMC Med Inform Decis Mak

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Background Accurate segmentation of critical anatomical structures in fetal four-chamber view images is essential for the early detection of congenital heart defects. Current prenatal screening methods rely on manual measurements, which are time-consuming and prone to inter-observer variability. This study develops an AI-based model using the state-of-the-art nnU-NetV2 architecture for automatic segmentation and measurement of key anatomical structures in fetal four-chamber view images. Methods A dataset, consisting of 1,083 high-quality fetal four-chamber view images, was annotated with 15 critical anatomical labels and divided into training/validation (867 images) and test (216 images) sets. An AI-based model using the nnU-NetV2 architecture was trained on the annotated images and evaluated using the mean Dice coefficient (mDice) and mean intersection over union (mIoU) metrics. The model’s performance in automatically computing the cardiac axis (CAx) and cardiothoracic ratio (CTR) was compared with measurements from sonographers with varying levels of experience. Results The AI-based model achieved a mDice coefficient of 87.11% and an mIoU of 77.68% for the segmentation of critical anatomical structures. The model’s automated CAx and CTR measurements showed strong agreement with those of experienced sonographers, with respective intraclass correlation coefficients (ICCs) of 0.83 and 0.81. Bland–Altman analysis further confirmed the high agreement between the model and experienced sonographers. Conclusion We developed an AI-based model using the nnU-NetV2 architecture for accurate segmentation and automated measurement of critical anatomical structures in fetal four-chamber view images. Our model demonstrated high segmentation accuracy and strong agreement with experienced sonographers in computing clinically relevant parameters. This approach has the potential to improve the efficiency and reliability of prenatal cardiac screening, ultimately contributing to the early detection of congenital heart defects.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Automatic segmentation of 15 critical anatomical labels and measurements of cardiac axis and cardiothoracic ratio in fetal four chambers using nnU-NetV2

Liang,

Peng,

Luo

et al. 2024

BMC Med Inform Decis Mak

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“…Current guidelines recommend an F-echo for mothers with CHD. The guidelines do not take into account if a LII-US was felt to be normal [ 8 , 9 ]. There is increasing data suggesting that a normal second-trimester screening ultrasound is unlikely to miss critical CHD [ 13 – 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…LII-US included 2D imaging and color Doppler analysis of the heart per guidelines [ 12 ]. All F-echoes were performed per guidelines and included 2D, color Doppler, and pulse/continuous wave Doppler analysis of the cardiac structures [ 8 , 9 ]. Post-natal transthoracic echocardiograms (pTTE) were reviewed if available.…”

Section: Methodsmentioning

confidence: 99%

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The Utility of Screening Fetal Echocardiograms Following Normal Level II Ultrasounds in Fetuses with Maternal Congenital Heart Disease

Calcara,

Paeltz,

Richards

et al. 2024

Cardiol Ther

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Introduction Fetal echocardiograms (F-echo) are recommended in all pregnancies when maternal congenital heart disease (CHD) is present, even if there was a prior level II ultrasound (LII-US) that was normal. The goal of this study was to evaluate if any diagnosis of a critical CHD was missed in a fetus with maternal CHD who had a normal LII-US. Methods A retrospective chart review of all F-echoes where the indication was maternal CHD between 1/1/2015 to 12/31/2022 was performed. Fetuses were included if they had a LII-US that was read as normal and had an F-echo. Critical CHD was defined as CHD requiring catheterization or surgical intervention < 1 month of age. Results A total of 296 F-echoes on fetuses with maternal CHD were evaluated, of which 175 met inclusion criteria. LII-US was performed at 19.8 ± 2.9 weeks gestational age and F-echo was performed at 24.2 ± 2.8 weeks gestational age. No patient with a normal LII-US had a diagnosis of a critical CHD by F-echo (negative predictive value = 100%). Evaluating those patients that had a negative LII-US, ten patients were diagnosed with non-critical CHD postnatally (negative predictive value = 94.3%). F-echo correctly diagnosed two of the ten missed LII-US CHD. Conclusions Critical CHD was not missed with a normal LII-US in this at risk population. F-echo also missed the majority of CHD when a LII-US was read as normal. A cost–benefit analysis of screening F-echo in fetuses with maternal CHD should be conducted if a normal LII-US has been performed.

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Feto‐maternal indicators of cardiac dysfunction as a justification for the cardiac origins for pre‐eclampsia

Reilly,

Watson,

Ruddock

et al. 2024

Intl J Gynecology & Obste

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While the pathophysiology of pre‐eclampsia has been postulated as being secondary to placental dysfunction, a cardiac origin has more recently been proposed. Although an association between fetal congenital cardiovascular disease and pre‐eclampsia has been demonstrated, no precise pathophysiologic mechanism for this association has been described. This review highlights the current biophysical (including echocardiography and Doppler indices) and biochemical (including proteomic, metabolomic and genetic/transcriptomic) markers of cardiac dysfunction that have been investigated in maternal and fetal cardiac disease and their overlap with predictors of pre‐eclampsia. Common pathways of inflammatory and anti‐angiogenesis imbalance, endothelial damage, and oxidative stress have been demonstrated in both cardiovascular disease and pre‐eclampsia and further investigation into these pathways could help to elucidate the common pathophysiologic mechanisms linking these disorders.

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Guidelines and Recommendations for Performance of the Fetal Echocardiogram: An Update from the American Society of Echocardiography

Cited by 56 publications

References 136 publications

Automatic segmentation of 15 critical anatomical labels and measurements of cardiac axis and cardiothoracic ratio in fetal four chambers using nnU-NetV2

Automatic segmentation of 15 critical anatomical labels and measurements of cardiac axis and cardiothoracic ratio in fetal four chambers using nnU-NetV2

The Utility of Screening Fetal Echocardiograms Following Normal Level II Ultrasounds in Fetuses with Maternal Congenital Heart Disease

Feto‐maternal indicators of cardiac dysfunction as a justification for the cardiac origins for pre‐eclampsia

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