Real-time three-dimensional fetal echocardiography using matrix probe

To investigate the feasibility of using real-time three-dimensional echocardiography (3DE) to evaluate the fetal heart.

Sixty fetuses were studied with gestational age between 22 and 34 weeks. The fetal heart was normal in 44 fetuses. In 16 fetuses, the fetal heart had morphologic abnormalities (hypoplastic left ventricle in 4, tetralogy of Fallot in 2, Ebstein anomaly in 2, rhabdomyomes in 2, hypoplastic right ventricle in 1) or myocardial dysfunction (in 5 fetuses). Real-time 3DE was performed with a cardiac matrix probe (2-4 MHz). Two modalities of 3D imaging were performed: Biplane and Live 3D imaging.

Real-time 3DE was performed successfully in 93%. Biplane imaging allowed a multiplanar scanning of the fetal heart. Using rotation, lateral and vertical tilts, the normal cardiac structures were identified from a unique reference image plane: atria and ventricles, atrioventricular valves, aorta and pulmonary artery. Live 3D imaging allowed surface imaging of the fetal heart. 'En face' view of the foramen ovale from the right atrium was obtained, showing the shape of the orifice. By cropping the pyramidal imaging volume, ascending aorta, aortic arch and ductus arteriosus were depicted from a single dataset. In pathologic fetal hearts, 3DE was helpful for (1) localizing multiple cardiac tumors; (2) estimating size and function of the right and left ventricles; (3) evaluating mechanism of valvular regurgitation and pulmonary obstruction.

Real-time 3DE is a feasible and non-time-consuming method, allowing a multiplanar scanning and new inside 3D views of the fetal heart.