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Fetal echocardiography: accuracy and limitations in a population at high and low risk for heart defects
B Bromley1, J A Estroff, S P Sanders
1Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA.
Insights
Prenatal echocardiography detected 83% of fetal heart defects. This screening is valuable for both high-risk and low-risk pregnancies, as many defects occur in low-risk groups.
Area of Science:
- Medical imaging
- Fetal medicine
- Cardiology
Background:
- Congenital heart defects (CHDs) are common birth anomalies.
- Accurate prenatal detection of CHDs is crucial for timely intervention and improved outcomes.
- Risk stratification for CHDs has traditionally focused on high-risk pregnancies.
Purpose of the Study:
- To evaluate the accuracy of prenatal echocardiography in identifying structural cardiac anomalies.
- To compare detection rates between high-risk and low-risk fetal populations.
- To assess the utility of specific echocardiographic views in CHD detection.
Main Methods:
- A retrospective review of 69 fetuses with confirmed congenital heart defects.
- Prenatal ultrasonography performed at or after 18 weeks' gestation.
- Standard four-chamber and outflow tract views were utilized; four-chamber view accuracy was analyzed separately.
Main Results:
- Prenatal ultrasonography identified 83% of fetuses with heart defects.
- Detection rates did not significantly differ between high-risk (39 fetuses) and low-risk (30 fetuses) groups.
- The four-chamber view alone detected only 63% of cardiac defects, highlighting the importance of outflow tract views.
Conclusions:
- Routine use of four-chamber and outflow tract views in fetal echocardiography is effective, detecting 83% of structural cardiac malformations.
- A significant proportion of fetuses with CHDs (43%) were identified in the low-risk group.
- Systematic fetal heart screening should extend beyond traditionally high-risk pregnancies.
Objective:
Our objective was to assess the accuracy of prenatal echocardiography in detecting congenital heart defects in patients at high and low risk for structural cardiac anomalies.
Study Design:
Sixty-nine consecutive fetuses with congenital heart defects who had had prenatal ultrasonography at greater than or equal to 18 weeks' gestation were evaluated to determine the accuracy of prenatal ultrasonography in identifying structural cardiac defects. Thirty-nine patients were at high risk and 30 patients were at low risk for cardiac anomalies. All fetuses were scanned with standard four-chamber and outflow tract views. Data concerning extracardiac anomalies and karyotypic abnormalities were tabulated. The accuracy of the four-chamber view alone in identifying congenital heart defects was evaluated.
Results:
Fifty-seven of 69 fetuses (83%) were prenatally identified ultrasonographically as having a heart defect. There was no difference in the sensitivity of detecting cardiac anomalies between high-risk and low-risk groups. When the four-chamber view was used, only 63% of fetuses were recognized as having an abnormal heart. Extracardiac anomalies were noted in 36% and karyotypic abnormalities in 17% of patients.
Conclusion:
The four-chamber and outflow tract views done routinely in an ultrasonography laboratory seeing a mixed population of patients was successful in detecting 83% of fetuses with structural cardiac malformations. Because 43% of the fetuses with heart defects were referred for low-risk indications, systematic ultrasonographic examination of the fetal heart should not be reserved only for those at high risk.