Reliability of the first‐trimester cardiac scan by ultrasound‐trained obstetricians with high‐frequency transabdominal probes in fetuses with increased nuchal translucency

Bellotti, M.; Fesslová, Vlasta; Gasperi, C. De; Rognoni, G.; Bée, Valerie; Zucca, I.; Cappellini, Anna; Bulfamante, Gaetano; Lombardi, Claudio

doi:10.1002/uog.7685

Cited by 34 publications

(43 citation statements)

References 26 publications

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“…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. 16,18,19 The two cardiac views we used can be easily adopted in a nuchal scan, as, according to our observations, the most common fetal position in the late first trimester is the transverse one, which increases the chance of successful visualization of basic cardiac views on color mapping within a few minutes. A simple direct method of cardiac evaluation is superior to the simplest first-trimester screening tool for congenital heart defects of using nuchal translucency thickness.…”

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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“…However, the recognition of increased nuchal translucency at 11 to 14 weeks' gestation as a marker for aneuploidies 2 and its association with an increased risk of congenital heart disease 3 , 4 have led to sonographic evaluation of the fetal heart at this early stage 5 – 7 . In fact, with modern sonographic equipment, an accurate evaluation of the heart in a high‐risk fetus can be made by experts in the first trimester 5 – 8 …”

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confidence: 99%

Diagnosis of Congenital Heart Disease by Early and Second-Trimester Fetal Echocardiography

Volpe¹,

Robertis²,

Campobasso³

et al. 2012

Journal of Ultrasound in Medicine

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“…If early fetal echocardiography is required, adding colour flow mapping to 2D mode is preferred [16] to a HFLT examination as the benefits of the latter is likely to be small from the findings of a previous [16] and the present studies. Training [13] [14], and a longer examination time of more than 10 minutes [13] can improve the successful rate.…”

Section: Discussionmentioning

confidence: 99%

“…Early studies suggested that the use of a HFLT together with colour flow mapping allowed successful examination of fetal heart in 85% of patients [13], could be completed within an acceptable length of time [13], performed with high accuracy [14] [15] offered a high negative predicted value [13], and allowed differentiation of normal and abnormal cardiac findings in the first trimester [14]. However, a subsequent randomized trial showed that the use of a high-frequency (at 7.5 MHz) linear transducer alone without colour flow mapping did not improve visualization of cardiac anatomy [16], probably because of its limited penetration, given that the visibility of cardiac anatomy was inversely correlated with the transducer-heart distance [16].…”

Section: Introductionmentioning

confidence: 99%

The Use of a High Frequency Linear Transducer in the Assessment of Fetal Anatomy at the Routine 11 to 13 + 6-Week Scan among Chinese Population

Mak¹,

Kou²,

Poon³

et al. 2015

OJOG

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Objectives: To determine if the use of high frequency linear transducer (HFLT) in addition to conventional curvilinear transducer (CCT) aids assessment of fetal cardiac and non-cardiac anatomy in the first trimester. Methods: Transabdominal CCT (4 -8 MHz) followed by HFLT (9 MHz) was used to study prospectively the visualization rate of basic and optional anatomical structures according to international guidelines. McNemar and Chi-square test were used to compare correlated and independent proportions respectively. Postnatal outcomes were traced. Results: Comparing with CCT alone, additional use of HFLT did not improve the completion rate of basic anomaly screen (95.0% vs. 97.0%, p = 0.5) in the 101 women studied, but it improved the visualization rate of some optional structures including lens (57.4% vs. 73.3%), three-vessel view (3 VV) (17.8% vs. 48.5%), left ventricular outflow tract (17.8% vs. 51.5%), kidneys (8.9% vs. 47.5%), and umbilical artery (86.1% vs. 93.1%) (all p < 0.05). Favourable fetal position was associated with a better visualisation of four-chamber view and 3VV (p < 0.05). Conclusions: Our findings supported that the use of HFLT in addition to CCT does not improve the completion of basic anomaly screen, nor does it achieve a high visualisation rate of different cardiac views in the first trimester.

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Reliability of the first‐trimester cardiac scan by ultrasound‐trained obstetricians with high‐frequency transabdominal probes in fetuses with increased nuchal translucency

Abstract: K E Y W O R D S:congenital heart disease; fetal echocardiography; fetal heart; first trimester; nuchal translucency ABSTRACT

Cited by 34 publications

References 26 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

Diagnosis of Congenital Heart Disease by Early and Second-Trimester Fetal Echocardiography

The Use of a High Frequency Linear Transducer in the Assessment of Fetal Anatomy at the Routine 11 to 13 + 6-Week Scan among Chinese Population

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