Obtaining the Four-Chamber View to Diagnose Fetal Cardiac Anomalies

Hess, Darla B.; Hess, L. Wayne; Carter, Guy A.; Floyd, Randall C.; Fraser, Robert F.

doi:10.1016/s0889-8545(05)70024-3

Cited by 8 publications

(3 citation statements)

References 12 publications

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“…However, recent studies demonstrate a maximum of 45±40% sensitivity of fourchamber view screening 3±6,9±11 . Even if the more accurate fetal echocardiography had a 100% sensitivity and 100% specificity, most congenital heart disease would not be detected in utero using this screening modality because more than 80% of neonatal congenital heart disease occurs in the low-risk population 3,17 . Additionally, fetal echocardiography for all pregnant women is not recommended either by the American or most European Colleges of Obstetricians and Gynecologists, and is not routinely available in all areas.…”

Section: Discussionmentioning

confidence: 99%

“…The four-chamber view of the fetal heart is currently used to screen for congenital heart disease and is included in the standard obstetric ultrasound examination 1,2 . Where the four-chamber view of the heart is entirely normal, 40% or less of fetal congenital heart defects can be excluded 3,4 . Four-chamber screening for congenital heart disease should only be performed in fetuses of a low-risk population with no indication for a full fetal echocardiogram 3±5 .…”

Section: Introductionmentioning

confidence: 99%

“…Four-chamber screening for congenital heart disease should only be performed in fetuses of a low-risk population with no indication for a full fetal echocardiogram 3±5 . Adding the five-chamber view to four-chamber view screening, by angling the transducer cephalad whilst maintaining the four-chamber view thus visualizing the ascending aorta with the aortic valve, as the fifth chamber, markedly improves the sensitivity of detecting congenital heart defects 3,6 . However, several retrospective and prospective studies have shown a wide variation ranging from 40 to 90%, in the sensitivity of detecting fetal congenital heart disease even when a full two-dimensional (2-D) fetal echocardiography has been performed 7±9 .…”

Section: Introductionmentioning

confidence: 99%

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Three‐dimensional (3‐D) ultrasonography for obtaining the four and five‐chamber view: comparison with cross‐sectional (2‐D) fetal sonographic screening

Meyer‐Wittkopf

Rappe

Sierra

et al. 2000

Ultrasound in Obstet & Gyne

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Considering the versatility of gated 3-D fetal cardiac imaging we believe that it may soon become an important component of fetal screening thus helping to retrieve standard cardiac cross sections when 2-D imaging is limited by lack of sonographer experience or sonographic windows. Diagnostically acceptable echocardiographic views were obtained more consistently with 2-D ultrasound than with 3-D volume data.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Three‐dimensional (3‐D) ultrasonography for obtaining the four and five‐chamber view: comparison with cross‐sectional (2‐D) fetal sonographic screening

Meyer‐Wittkopf

Rappe

Sierra

et al. 2000

Ultrasound in Obstet & Gyne

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The Four-Chamber View

2008

Echocardiographic Anatomy in the Fetus

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Fetal echocardiography

Srinivasan

2000

Indian J Pediatr

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Since the first report of fetal echocardiography in 1972 by Winsberg, several advances in ultrasound technology have occurred allowing detailed evaluation of cardiac anatomy in the second trimester fetus. Fetal echo is indicated in high risk pregnancies where the chances of fetus having a congenital heart disease (CHD) are likely to be high e.g., in fetus with extracardiac anomalies picked up on obstetric ultrasound, those with a history of CHD in family, maternal diabetes (especially insulin dependent), maternal connective tissue disorder etc. The reported sensitivity of fetal echo has ranged from 4-96% in various series depending upon the equipment, level of training, study design and examination technique. Although many CHD can be detected in four chamber view, an important group malformations that would need early intervention are likely to be missed. Hence a detailed echocardiographic examination including the outflow views must be done. Defects like atrial septal defect and patent ductus arteriosus cannot be diagnosed in fetal echo, as these are part of normal fetal physiology. Other CHD like coarctation of aorta, small ventricular septal defects, mild valvular stenosis, partial anomalous pulmonary venous drainage are also difficult to diagnose. Ultrasound assessment of fetus, however, has a clear role in the diagnosis, monitoring and management of fetuses with sustained arrhythmias. Prenatal diagnosis of CHD helps in planning the optimal management of the baby e.g. a fetus with a ductus dependent lesion can be planned to be delivered in a tertially care centre for stabilisation and early initiation of prostaglandin therapy to avoid acidosis and organ damage. Future of fetal medicine lies in fetal cardiac surgery for which echocardiography will play a very important role.

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Obtaining the Four-Chamber View to Diagnose Fetal Cardiac Anomalies

Cited by 8 publications

References 12 publications

Three‐dimensional (3‐D) ultrasonography for obtaining the four and five‐chamber view: comparison with cross‐sectional (2‐D) fetal sonographic screening

Three‐dimensional (3‐D) ultrasonography for obtaining the four and five‐chamber view: comparison with cross‐sectional (2‐D) fetal sonographic screening

The Four-Chamber View

Fetal echocardiography

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