Fetal echocardiography in three and four dimensions

A three-dimensional (3D) acquisition system using an electromagnetic position sensor attached to a standard transducer on an unmodified ultrasound scanner was developed to capture two-dimensional (2D)-fetal echocardiograms at various positions and orientations. Operating in real-time directed M-mode allowed recording of 2D structural images and cardiac motion curves, from which the fetal cardiac phase could be determined. By digitising over 100 image frames for each scanning sequence, and by selecting frames at particular phases, 3D views of the fetal heart were reconstructed for each phase. Of 20 sequences of six fetuses scanned, 13 sequences successfully demonstrated usable 3D fetal heart structures, including four cardiac chambers, ventricular and atrial septa, foramen ovale and some of the cardiac valves and great vessels. Rearrangement of those phased 3D images into a cyclic sequence could generate dynamic 3D views of a beating fetal heart. We believe that, with further technical development, this new approach will be of use in the diagnosis of prenatal cardiac malformations and malfunctions, in in utero cardiac surgery and in fetal cardiology teaching.