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The spectrum of fetal cardiac malformations
1Cardiac Unit, Institute of Child Health, University College London, UK. a.cook@ich.ucl.ac.uk
Insights
Prenatal diagnosis of fetal heart malformations requires specific echocardiographic views. A systematic sweep from the four-chamber plane to cranial views is essential for detecting the full spectrum of cardiac anomalies.
Area of Science:
- Cardiology
- Prenatal Diagnosis
- Medical Imaging
Background:
- Paediatric cardiologists increasingly diagnose cardiac malformations prenatally.
- Prenatal diagnosis presents unique challenges compared to postnatal evaluation, including different encounter frequencies and imaging views.
Purpose of the Study:
- To describe the anatomical spectrum of cardiac malformations identified in a large cohort of fetuses.
- To illustrate the distribution of anomalies based on echocardiographic views, from the four-chamber plane to more cranial sections.
Main Methods:
- Review of 917 fetal hearts examined consecutively following prenatal diagnosis.
- Systematic anatomical description of malformations using a sweep approach through fetal thoracic views.
Main Results:
- Two-thirds of cardiac anomalies were detectable from the four-chamber plane.
- Tricuspid valve abnormalities significantly alter four-chamber views, but represent a minority of total anomalies.
- Atrioventricular septal defects require detailed intracardiac inspection and form a large proportion of cases.
- Up to one-third of anomalies necessitated views cranial to the four-chamber plane, including outflow tracts and arterial arches.
Conclusions:
- A comprehensive prenatal diagnosis of fetal cardiac abnormalities requires consideration of multiple echocardiographic planes.
- Systematic examination, including outflow tracts and arterial arches, is crucial for complete detection.
Abstract:
Increasingly, paediatric cardiologists are called upon to diagnose cardiac malformations prenatally. In the main, the types of malformation seen during fetal life will be similar to those documented postnatally, but the frequency with which they are encountered, as well as the views that can be used for diagnosis, will be different. This review aims to describe the anatomic spectrum of malformations seen in 917 fetal hearts examined consecutively following prenatal diagnosis. The distribution of anomalies is illustrated in terms of a simple sweep through the fetal thorax passing from the four-chamber plane to the outflow tracts, and then to more cranial views of the mediastinum. Two-thirds of the anomalies described would have been detectable in the four-chamber plane. Some, such as tricuspid valvar abnormalities, will alter the normal appearances of the four-chambers dramatically. In terms of the overall spectrum, however, such obvious abnormalities only form a minor part of the total number. Others, such as atrioventricular septal defect, will often require closer inspection of intracardiac anatomy, but will make up a large proportion of the entire cohort. Up to one third of the anomalies in the series would have required views more cranial to the four-chamber plane of section. In these, it would have been necessary to examine the nature of the left ventricular outflow tract, the crossing of the two outflows, or else the arterial arches in order to secure detection. In the fetus, these and other planes must be considered by the echocardiographer in order completely to detect and document the entire spectrum of cardiac abnormalities likely to be encountered.