Prenatal Screening for Major Congenital Heart Disease

Sklansky, Mark; Berman, Darren P.; Pruetz, Jay D.; Chang, Ruey‐Kang R.

doi:10.7863/jum.2009.28.7.889

Cited by 81 publications

(27 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…During the timeframe of this study, basic fetal cardiac screening relied mostly on a 4CV 30,31 and this likely contributes to our findings of low detection rates for defects such as TGA, TOF and DORV which require OFTVs for diagnosis. It has been shown that OFTVs are more likely to be abnormal in mid-gestation screening for fetuses with critical forms of CHD while 4CV detect smaller percentage of critical CHD cases 10 . Recently, obstetrical guidelines have been updated to recommend OFTVs in addition to the 4CV during second trimester screening ultrasound 32 .…”

Section: Discussionmentioning

confidence: 99%

Variation in Prenatal Diagnosis of Congenital Heart Disease in Infants

et al. 2015

View full text Add to dashboard Cite

Background Prenatal diagnosis allows for improved peri-operative outcomes of fetuses with certain forms of congenital heart disease (CHD). Variability in prenatal diagnosis has been demonstrated in other countries, leading to efforts to improve fetal imaging protocols and access to care, but has not been examined across the United States. Objective To evaluate national variation in prenatal detection across geographic region and defect type in neonates and infants with CHD undergoing heart surgery. Methods Cardiovascular operations performed in patients ≤ 6 months of age within the United States and included in the STS-CHS Surgical Database (2006–2012) were eligible for inclusion. Centers with >15% missing prenatal diagnosis data were excluded from the study. Prenatal diagnosis rates were compared across geographic location of residence and defect type using the Chi-square test. Results Overall, the study included 31,374 patients from 91 STS-CHS participating centers across the United States. Prenatal detection occurred in 34% and increased every year from 26% (2006) to 42% (2012). There was significant geographic variation in rates of prenatal diagnosis across states (range 11.8 – 53.4%, p < 0.0001). Significant variability by defect type was also observed with higher rates for lesions identifiable on 4-chamber view versus those requiring outflow tract visualization (57% versus 32%, p < 0.0001). Conclusions Rates of prenatal CHD detection in the United States remain low for patients undergoing surgical intervention, with significant variability between states and across defect type. Further studies are needed to identify reasons for this variation and the potential impact on patient outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Variation in Prenatal Diagnosis of Congenital Heart Disease in Infants

et al. 2015

View full text Add to dashboard Cite

show abstract

“…3 Yet, the prenatal detection of CHD has remained challenging, with the sensitivity of ultrasound ranging from 15–39%. 4–12 This has been attributed mainly to operator skill and expertise; 13–18 however, other factors include the complex anatomy, motion, and small size of the fetal heart. The lack of prenatal identification of CHD is associated with adverse consequences for the neonate, including abnormal neurological development, and even death.…”

Section: Introductionmentioning

confidence: 99%

Fetal Intelligent Navigation Echocardiography (FINE) Detects 98% of Congenital Heart Disease

Yeo

Luewan

Romero

2018

J of Ultrasound Medicine

View full text Add to dashboard Cite

Objective Fetal Intelligent Navigation Echocardiography (FINE) is a novel method that automatically generates and displays nine standard fetal echocardiography views in normal hearts by applying intelligent navigation technology to spatiotemporal image correlation (STIC) volume datasets. The main objective was to determine the sensitivity and specificity of FINE in the prenatal detection of congenital heart disease (CHD). Methods A case-control study was conducted in 50 fetuses with a broad spectrum of CHD (cases) and 100 fetuses with normal hearts (controls) in the second and third trimesters. Using four-dimensional ultrasound with STIC technology, volume datasets were acquired. After all identifying information was removed, the datasets were randomly distributed to a different investigator for analysis using FINE. The sensitivity and specificity for the prenatal detection of CHD, as well as positive and negative likelihood ratios (LR) were determined. Results The diagnostic performance of FINE for the prenatal detection of CHD was: sensitivity 98% (49/50), specificity 93% (93/100), positive LR of 14, and negative LR of 0.02. Among cases with confirmed CHD, the diagnosis based upon FINE completely matched the final diagnosis in 74% (37/50), minor discrepancies were seen in 12% (6/50), and major discrepancies were seen in 14% (7/50). Conclusions We present for the first time the sensitivity and specificity of the FINE method in fetuses with normal hearts and CHD in the second and third trimesters. Since FINE identifies a broad spectrum of CHD with 98% sensitivity, this method could be used prenatally to screen for and diagnose CHD.

show abstract

“…Also, AIUM has proposed similar guidelines [ 28 , 29 ]. It is therefore a very important step in improving detection of CHD by complementing the 4CV with the outflow tract views under these guidelines, as documented by several teams and regional studies [ 13 , 15 ]. Theoretically, most cardiac anomalies can be detected if all the planes could be acquired and the image data interpretations are made correctly.…”

Section: Discussionmentioning

confidence: 99%

“…A symmetric four-chamber view (4CV) has been used to confirm a normal fetal heart since the early 1990s [ 11 , 12 ]. However, it is well-documented that 4CV alone is inadequate in ruling out conotruncal anomalies [ 13 – 15 ]. The ISUOG guideline [ 16 ] has been revised and updated to include more cardiac views that improve the efficiency of prenatal screening for CHD.…”

Section: Introductionmentioning

confidence: 99%

Identification of fetal cardiac anatomy and hemodynamics: a novel enhanced screening protocol

Zhang

Cai

Ren

et al. 2016

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

BackgroundPrenatal cardiac screening is of great importance as it contributes to appropriate neonatal management and helps parents to make a decision regarding their pregnancy. The aim of our study was to evaluate the efficiency of a newly proposed screening protocol in the detection of fetal congenital heart disease (CHD).MethodsThis was a prospective study. A total of 52 cases of confirmed CHD fetuses and 248 cases of randomly selected normal fetuses were included in the study. Two sonographers with similar experience performed the cardiac screenings under two different protocols independently. The conventional protocol (Protocol A) paid greater attention to the four-chamber view and the outflow tract views. A 6-month training program was provided to sonographers performing scans under the new protocol (Protocol B), which emphasized systematically evaluating fetal cardiac anatomy and hemodynamics. Color Doppler was mandatory and some ultrasonic signs for special cardiac anomalies were also introduced into this protocol.ResultsProtocol B detected more cardiac anomalies than did Protocol A (96.2 % vs. 61.5 %, P < 0.01). Specifically, Protocol B was superior to Protocol A in detecting cardiac malpositions, abnormal systemic and pulmonary venous connection, right aortic arch, transposition of the great arteries, and congenital corrected transposition of the great arteries. By visualizing flow disturbance and retrograde flow with color Doppler, Protocol B was better than Protocol A in screening valvular associated malformations, such as pulmonary atresia, pulmonary stenosis, tricuspid dysplasia, etc. For the normal fetuses, Protocol B was better than Protocol A in reducing the false-positive detection of septal defects.ConclusionsThe current study introduces an enhanced protocol for fetal cardiac screening, under which the obstetric screening sonographers systematically identify fetal cardiac anatomy and hemodynamics. A short-term training program makes it possible for the screening sonographers to become familiar with the new protocol, and its value has been confirmed due to improvements made in screening efficiency.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-0933-9) contains supplementary material, which is available to authorized users.

show abstract

Prenatal Screening for Major Congenital Heart Disease

Cited by 81 publications

References 41 publications

Variation in Prenatal Diagnosis of Congenital Heart Disease in Infants

Variation in Prenatal Diagnosis of Congenital Heart Disease in Infants

Fetal Intelligent Navigation Echocardiography (FINE) Detects 98% of Congenital Heart Disease

Identification of fetal cardiac anatomy and hemodynamics: a novel enhanced screening protocol

Contact Info

Product

Resources

About