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Fetal Mouse Cardiovascular Imaging Using a High-frequency Ultrasound (30/45MHZ) System
Published on: May 5, 2018
Factors influencing the prenatal detection of structural congenital heart diseases
S F Wong1, F Y Chan, R B Cincotta
1Department of Maternal Fetal Medicine, Mater Mothers' Hospital, South Brisbane, Queensland, Australia. shellwong@hotmail.com
Insights
Prenatal ultrasound detected 40.4% of congenital heart diseases (CHDs). Detection rates improved with complex lesions, experienced sonographers, and additional anomalies, highlighting areas for enhanced prenatal screening.
Area of Science:
- Perinatology
- Fetal Medicine
- Cardiology
Background:
- Congenital heart diseases (CHDs) are a significant cause of infant mortality and morbidity.
- Prenatal detection of structural CHDs is crucial for improving perinatal outcomes.
- Factors influencing the accuracy of prenatal CHD detection require further investigation.
Purpose of the Study:
- To evaluate the key determinants affecting the prenatal detection rate of structural congenital heart diseases (CHDs).
- To identify specific lesion types and patient characteristics associated with higher detection rates.
- To assess the impact of sonographer experience and co-existing anomalies on diagnostic accuracy.
Main Methods:
- Retrospective analysis of fetal and infant medical records with diagnosed CHDs.
- Inclusion of pregnancies with prenatal ultrasound morphological surveys.
- Assessment of lesion complexity, sonographer experience, co-existing anomalies, and maternal BMI as influencing factors.
Main Results:
- The overall prenatal detection rate for structural CHDs was 40.4%.
- Detection rates were significantly higher for complex lesions (54%), lesions with abnormal four-chamber views (62.9%), and concomitant septal defects (66.7%).
- Higher detection rates were observed in tertiary institutions and when chromosomal or structural anomalies were present; maternal BMI was not a significant factor.
Conclusions:
- While major CHDs can be detected with a high rate in screening settings, significant improvements are needed.
- Enhanced scanning skills, particularly in four-chamber view and great-artery analysis, are essential in both tertiary and local centers.
- Operator experience and lesion complexity are critical independent predictors of successful prenatal CHD detection.
Objective:
To assess the factors influencing the prenatal detection rate of structural congenital heart diseases (CHDs).
Methods:
A retrospective study was conducted at a major obstetric hospital in Australia between 1 January 1996 and 30 June 1999. The medical records of all fetuses and infants born with CHD, except those with isolated patent ductus arteriosus or secundum atrial septal defect, were reviewed. Only pregnancies that had prenatal ultrasound scan assessments for morphological surveys were included. The following factors that may influence the detection rate were assessed: complexity of the lesions; experience of the sonographers (performance in tertiary versus non-tertiary institutions); presence of other structural or chromosomal anomalies; and maternal body mass index (BMI).
Results:
The incidence of structural CHD in this series, excluding cases referred from other hospitals, was 7.0 per 1000 (179/25 529). Of the 179 pregnancies with CHD, 151 had prenatal ultrasound scans and were included in the study. The overall detection rate for CHDs in this series was 40.4%. The detection rate for isolated septal defects was poor (13.7%). The detection rates were significantly higher for complex lesions (54%), for lesions with concomitant septal defects (66.7%), and for lesions with abnormal four-chamber views (62.9%). The detection rate was also higher if the scan was performed in the tertiary institution, and if there were other chromosomal or structural anomalies. Maternal BMI did not affect the detection rate in the current series. Stepwise logistic regression analysis showed that three independent variables affecting the detection rate were complexity of the cardiac lesion, experience of the operator, and the detection of chromosomal anomalies.
Conclusion:
A high detection rate for major CHDs can be achieved in a screening setting but there is still room for improvement in scanning skills in the four-chamber view and great-artery analysis in both tertiary and local centers.
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