Transient abnormal fetal cardiac flow patterns at 13 to 17 gestational weeks

Abstract

The transient sonographic findings at 13 to 17 weeks' gestation of mitral regurgitation, pulmonary or aortic high valvular flow, and coronary sinus flow have a good prognosis, and in most cases are not associated with persistent cardiac anomalies. The etiology, incidence, and the prognosis of fetuses with transient ABCFP at 13 to 17 weeks' gestation are different from what is observed when the same occurs later in gestation.

Diverse outcome following early prenatal diagnosis of pulmonary stenosis

“…In our experience, 99% of fetal cardiac anomalies, with the exception of PS and leiomyoma of myocardium, are detectable by the early mid-trimester screen at 14-17 weeks, and over 90% of them are detected in the low-risk population. In previous studies, we detected almost all of the severe fetal cardiac malformations (hundreds of such cases) in the early second trimester 12,14,15 .…”

“…In these cases, a distinction was made between the finding of pure PS and the more severe finding of pulmonary atresia with an intact ventricular septum. Most cases were described in fetuses beyond the age of 17 weeks; with the exception of our previous report of 11 cases from our current cohort, there have been no publications on the early prenatal diagnosis of PS.…”

“…Early sonographic prenatal screening at 14-17 weeks of gestation has been performed routinely in Israel since 1987, and is now the standard of care in most pregnant women 14,15 . More than 30% of patients in Israel also undergo fetal echocardiography during this early mid-trimester examination, often at private institutions such as ours; there are sufficient obstetricians in Israel who are experienced in fetal sonography to supply this service to all interested parturients 14,15 . In our experience, 99% of fetal cardiac anomalies, with the exception of PS and leiomyoma of myocardium, are detectable by the early mid-trimester screen at 14-17 weeks, and over 90% of them are detected in the low-risk population.…”

“…Color and pulsed Doppler were performed across the four valves. Flow velocity across the pulmonary valve in early gestation is considered normal at < 60 cm/s. In cases in which abnormal flow was detected, for example cases with turbulence across the valve (Figure a), flow velocity > 100 cm/s (Figure b) or pulmonary regurgitation (Figure c), occasionally with retrograde pulmonary flow (Figure d), PS was suspected and the examination was repeated at 17–19 weeks and monthly thereafter, until delivery or resolution of the finding.…”

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

“…It was discovered that transient abnormal fetal cardiac flow patterns could be identified during this period. 5 On the other hand, pulsed wave Doppler venous pulsatility index measurement protocols are difficult to follow by nonexperienced examiners and are at risk of low reproducibility at primary fetal ultrasound centers. 6 Early fetal echocardiography is generally defined as a fetal cardiac scan performed until 16 weeks' gestation.…”