Clinical value of echocardiography using five views in diagnosing fetal severe congenital heart malformations in first trimester
Luan Zedong1, Yang Nan2, Qi Hongmin3, Pang Wenyan4, Wang Xiaoyan1, Zou Yanli1, Liu Yaqin1, Wang Haoling1, Zhang Jinting1
1Department of Ultrasound, 2Department of Surgery, 3Department of Clinical Examination, 4Department of Obstetrics and Gynecology, Laizhou Maternity and Child Healthcare Hospital, Laizhou 261400, China
Abstract：ObjectiveTo explore the clinical value of echocardiography to detect severe congenital cardiac abnormalities in fetus during the first trimester using five views (UAT, 4C, LVOT, RVOT, and 3VT). MethodsFrom April 2019 to January 2022, a total of 5323 fetuses at 11 to 14 weeks of gestation who received standardized ultrasound examination during early pregnancy at Laizhou Maternal and Child Healthcare Hospital were selected. Five sections of ultrasound were used for the cardiac ultrasound examination. First trimester fetal echocardiogram data were compared with second trimester fetal echocardiography or autopsy after induction and postnatal neonatal echocardiography outcomes. ResultsTwenty-two cases of severe cardiac malformations were diagnosed by echocardiography in 5323 fetuses. There was no fistula found in the second trimester or fetal echocardiography and autopsy after induction in 1 case of coronary artery fistula who was diagnosed in the first trimester. Three cases were missed: 1 of the congenital vascular ring (right arch catheter with aberrant left subclavian artery), 1 of a persistent left superior vena cava with the absence of right superior vena cava, and 1 of pulmonary atresia with intact ventricular septum. All 25 cases of fetal heart malformations were proved by autopsy after induction or second trimester or prenatal echocardiogram and postnatal neonatal echocardiography. The sensitivity and specificity of ultrasound five views in detecting fetal severe heart malformation in the first trimester were 87.50%(21/24) and 99.98%(5299/5300), respectively. In five views of ultrasound, the first trimester ultrasonographic features of fetal severe heart malformations include abnormal position of abdominal viscera and great vessels, abnormal heart position, abnormal cardiac axial angle, not four heart cavities structure, unsymmetrical size of four heart cavities, disappearance of cross, atrial septal defect, ventricular septal defect, atrioventricular valve regurgitation, abnormal connection, number, position and diameter ratio of great vessels, increased angle between ascending aorta and aortic arch, the color "y" sign, the color "U" sign, the reverse flow of aortic and ductus arteries, etc. ConclusionThe echocardiography using five views is very effective, and useful in diagnosing fetal severe heart malformations in the first trimester, but atrial septal defect, ventricular septal defect and persistent left superior vena cava may be missed during diagnosis.
栾泽东 杨楠 綦洪敏 庞文艳 王晓燕 邹艳丽 刘亚琴 王好玲 张锦婷. 超声五切面在早孕期诊断胎儿严重心脏
畸形中的临床价值[J]. 中华诊断学电子杂志, 2023, 11(3): 190-197.
Luan Zedong1, Yang Nan2, Qi Hongmin3, Pang Wenyan4, Wang Xiaoyan1, Zou Yanli1, Liu Yaqin1, Wang Haoling1, Zhang Jinting1. Clinical value of echocardiography using five views in diagnosing fetal severe congenital heart malformations in first trimester. zhzdx, 2023, 11(3): 190-197.
