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Prenatal screening for congenital heart disease with four-chamber and outflow-tract views: a multicenter study
G Oggè1, P Gaglioti, S Maccanti
1Department of Obstetrics and Gynaecology, University of Turin, Turin, Italy. giovanna.ogge@unito.it
Insights
Combining four-chamber and outflow-tract views in prenatal ultrasound significantly improved congenital heart disease detection rates. This enhanced screening method offers better diagnostic accuracy for expectant parents.
Area of Science:
- Medical Imaging
- Obstetrics
- Cardiology
Background:
- Congenital heart diseases (CHD) are the most common congenital anomalies, often occurring in low-risk populations.
- Current prenatal ultrasound screening, primarily using the four-chamber view, has shown limited success in detecting CHD.
- Improved detection methods are crucial for early intervention and management of fetal cardiac anomalies.
Purpose of the Study:
- To evaluate the diagnostic accuracy of prenatal ultrasound screening for CHD.
- To assess the effectiveness of combining the four-chamber view with outflow-tract views for improved detection.
- To compare the diagnostic performance of the combined views against the four-chamber view alone.
Main Methods:
- A multicenter prospective observational study was conducted across 15 obstetric units in Italy.
- Operators received specialized training on visualizing the four-chamber and outflow-tract views during routine scans.
- Diagnostic accuracy was calculated using follow-up data from newborns until hospital discharge.
Main Results:
- 9074 scans were performed, with follow-up data available for 6368 pregnancies.
- Fifty-eight cases of CHD were identified, with 38 diagnosed prenatally.
- The combined four-chamber and outflow-tract view screening achieved a sensitivity of 65.5% and specificity of 99.7%.
Conclusions:
- The enhanced ultrasound screening protocol demonstrated significantly higher sensitivity for CHD detection compared to previous methods.
- The improvement is attributed to the inclusion of outflow-tract views, technological advancements, and operator training.
- This approach offers a more effective strategy for prenatal diagnosis of congenital heart diseases.
Objective:
Congenital heart diseases (CHD) are the most common congenital anomalies, and most cases occur in the low-risk population. Prenatal ultrasound screening based on visualization of the four-chamber view has had disappointing results in detecting these anomalies thus far. The aim of this study was to evaluate the diagnostic accuracy of ultrasound screening based on the combination of the four-chamber and outflow-tract views.
Methods:
We conducted a multicenter prospective observational study in 15 obstetric units in the Piedmont Region, Italy. All operators received specific training. Data were recorded regarding visualization of the four-chamber view and the outflow tracts at each routine scan in pregnancies without any risk factor. When an anomaly was suspected, the patient was sent to the referral center. We obtained the follow-up data of the newborns until discharge from hospital and calculated the diagnostic accuracy of the test.
Results:
9074 ultrasound scans were performed on 7041 women and complete follow-up information was available for 6368 of them. Fifty-eight cases of CHD were observed at birth or postmortem (prevalence 9.1 per thousand); 38 of them were diagnosed in utero. The sensitivity of the test was 65.5%, the specificity 99.7%, the positive predictive value 70.4% and the negative predictive value 99.7%. The sensitivity of the four-chamber view alone was 60.3%.
Conclusions:
The sensitivity was significantly higher than that in a similar study performed in 1997 in the same setting. This improvement can be attributed in part to extension of the examination to the outflow-tract view, but also to technological developments and better training of the operators.
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