Color Doppler Patterns' Recognition Indicative of Congenital Heart Defects at the First-Trimester Referral Scan

Area of Science:

• Prenatal diagnosis
• Fetal medicine
• Cardiology

Background:

• First-trimester scans in high-risk pregnancies utilize an extended protocol including fetal heart assessment.
• Expert fetal medicine operators perform these scans.

Purpose of the Study:

• To evaluate inter-operator agreement in characterizing the four-chamber view (4CV) and three vessels and trachea view (3VTV).
• To assess agreement in both normal and abnormal cases using color Doppler.

Main Methods:

• Retrospective review of 2D images and video clips of 4CV and 3VTV in 90 fetuses (45 with congenital heart disease, 45 controls).
• Two independent operators and a fetal cardiologist, blinded to diagnoses, assessed specific patterns and abnormalities.
• Agreement measured using Cohen's Kappa.

Main Results:

• Perfect agreement (Kappa = 1) observed in normal cases.
• Almost perfect agreement for 4CV (Kappa = 0.83-0.96) and substantial agreement for 3VTV (Kappa = 0.77-0.80) in congenital heart disease cases.
• Lowest agreement noted for ventricular disproportion (4CV) and vessel number/size abnormalities (3VTV).

Conclusions:

• Expert operators demonstrate strong agreement in interpreting 4CV and 3VTV during first-trimester scans.
• Certain abnormalities, specifically ventricular disproportion and vessel anomalies, pose consistent interpretation challenges.