Routine use of color Doppler in fetal heart scanning in a low-risk population

Torbjørn Moe Eggebø, Claudia Heien, Magne Berget, Christian Lycke Ellingsen, Torbjørn Moe Eggebø, Claudia Heien, Magne Berget, Christian Lycke Ellingsen

Abstract

Objectives. To investigate the detection rate of major fetal heart defects in a low-risk population implementing routine use of color Doppler. Material and Methods. In a prospective observational study, all women undergoing fetal heart scanning (including 6781 routine examinations in the second trimester) during a three-year period were included. First a gray-scale scanning was performed including assessment of the four-chamber view and the great vessels. Thereafter three cross-sectional planes through the fetal thorax were assessed with color Doppler. Results. Thirty-nine fetuses had major heart defects, and 26 (67%) were prenatally detected. In 9/26 (35%) of cases the main ultrasound finding was related to the use of color Doppler. The survival rate of live born children was 91%. Conclusions. Routine use of color Doppler in fetal heart scanning in a low-risk population may be helpful in the detection of major heart defects; however, still severe malformations were missed prenatally.

Figures

Figure 1
Figure 1
Three-vessel view illustrating retrograde blood flow in the pulmonary artery.
Figure 2
Figure 2
Unilateral perfusion of right ventricle in fetus with hypoplastic left heart syndrome.
Figure 3
Figure 3
Displacement and insufficiency of the tricuspid valve (Ebstein's anomaly).

References

    1. Dolk H, Loane M, Garne E. Congenital heart defects in Europe: prevalence and perinatal mortality, 2000 to 2005. Circulation. 2011;123(8):841–849.
    1. Allan L, Benacerraf B, Copel JA, et al. Isolated major congenital heart disease. Ultrasound in Obstetrics & Gynecology. 2001;17(5):370–379.
    1. Blyth M, Howe D, Gnanapragasam J, Wellesley D. The hidden mortality of transposition of the great arteries and survival advantage provided by prenatal diagnosis. International Journal of Obstetrics and Gynaecology. 2008;115(9):1096–1100.
    1. Copel JA, Tan ASA, Kleinman CS. Does a prenatal diagnosis of congenital heart disease alter short-term outcome? Ultrasound in Obstetrics and Gynecology. 1997;10(4):237–241.
    1. Sharland G. Fetal cardiac screening: why bother? Archives of Disease in Childhood. 2010;95(1):F64–F68.
    1. Carvalho JS, Mavrides E, Shinebourne EA, Campbell S, Thilaganathan B. Improving the effectiveness of routine prenatal screening for major congenital heart defects. Heart. 2002;88(4):387–391.
    1. Chaoui R. The four-chamber view: four reasons why it seems to fail in screening for cardiac abnormalities and suggestions to improve detection rate. Ultrasound in Obstetrics and Gynecology. 2003;22(1):3–10.
    1. Acharya G, Sitras V, Maltau JM, et al. Major congenital heart disease in Northern Norway: shortcomings of pre- and postnatal diagnosis. Acta Obstetricia et Gynecologica Scandinavica. 2004;83(12):1124–1129.
    1. Tegnander E, Williams W, Johansens OJ, Blaas HGK, Eik-Nes SH. Prenatal detection of heart defects in a non-selected population of 30149 fetuses-detection rates and outcome. Ultrasound in Obstetrics and Gynecology. 2006;27(3):252–265.
    1. Westin M, Saltvedt S, Bergman G, et al. Routine ultrasound examination at 12 or 18 gestational weeks for prenatal detection of major congenital heart malformations? A randomised controlled trial comprising 36 299 fetuses. International Journal of Obstetrics and Gynaecology. 2006;113(6):675–682.
    1. Galindo A, Herraiz I, Escribano D, Lora D, Melchor JC, De La Cruz J. Prenatal detection of congenital heart defects: a survey on clinical practice in Spain. Fetal Diagnosis and Therapy. 2011;29(4):287–295.
    1. Tegnander E, Eik-Nes SH. The examiner’s ultrasound experience has a significant impact on the detection rate of congenital heart defects at the second-trimester fetal examination. Ultrasound in Obstetrics and Gynecology. 2006;28(1):8–14.
    1. McBrien A, Sands A, Craig B, Dornan J, Casey F. Impact of a regional training program in fetal echocardiography for sonographers on the antenatal detection of major congenital heart disease. Ultrasound in Obstetrics and Gynecology. 2010;36(3):279–284.
    1. Chew C, Stone S, Donath SM, Penny DJ. Impact of antenatal screening on the presentation of infants with congenital heart disease to a cardiology unit. Journal of Paediatrics and Child Health. 2006;42(11):704–708.
    1. Simpson LL. Screening for congenital heart disease. Obstetrics and Gynecology Clinics of North America. 2004;31(1):51–59.
    1. Lee W, Allan L, Carvalho JS, et al. ISUOG consensus statement: what constitutes a fetal echocardiogram? Ultrasound in Obstetrics and Gynecology. 2008;32(2):239–242.
    1. Chaoui R, McEwing R. Three cross-sectional planes for fetal color Doppler echocardiography. Ultrasound in Obstetrics and Gynecology. 2003;21(1):81–93.
    1. International Society of Ultrasound in Obstetrics & Gynecology. Cardiac screening examination of the fetus: guidelines for performing the “basic” and “extended basic” cardiac scan. Ultrasound in Obstetrics & Gynecology. 2006;27(1):107–113.
    1. Fetal Echocardiography Task Force. AIUM practice guideline for the performance of fetal echocardiography. Journal of Ultrasound in Medicine. 2011;30(1):127–136.
    1. Salvesen K, Lees C, Abramowicz J, Brezinka C, Ter Haar G, Marsal K. ISUOG statement on the safe use of Doppler in the 11 to 13 +6-week fetal ultrasound examination. Ultrasound in Obstetrics & Gynecology. 2011;37(6):p. 628.
    1. Yagel S, Arbel R, Anteby EY, Raveh D, Achiron R. The three vessels and trachea view (3VT) in fetal cardiac scanning. Ultrasound in Obstetrics and Gynecology. 2002;20(4):340–345.
    1. Tegnander E, Eik-Nes SH, Linker DT. Incorporating the four-chamber view of the fetal heart into the second-trimester routine fetal examination. Ultrasound in Obstetrics & Gynecology. 1994;4(1):24–28.
    1. Del Bianco A, Russo S, Lacerenza N, et al. Four chamber view plus three-vessel and trachea view for a complete evaluation of the fetal heart during the second trimester. Journal of Perinatal Medicine. 2006;34(4):309–312.
    1. Yoo SJ, Lee YH, Kim ES, et al. Three-vessel view of the fetal upper mediastinum: an easy means of detecting abnormalities of the ventricular outflow tracts and great arteries during obstetric screening. Ultrasound in Obstetrics and Gynecology. 1997;9(3):173–182.
    1. Vinals F, Heredia F, Giuliano A. The role of the three vessels and trachea view (3 VT) in the diagnosis of congenital heart defects. Ultrasound in Obstetrics & Gynecology. 2003;22(4):358–367.
    1. Allan L. Fetal cardiac scanning today. Prenatal Diagnosis. 2010;30(7):639–643.
    1. Wren C, Reinhardt Z, Khawaja K. Twenty-year trends in diagnosis of life-threatening neonatal cardiovascular malformations. Archives of Disease in Childhood. 2008;93(1):F33–F35.

Source: PubMed

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