Author + information
- Darren Hutchinson,
- Angela McBrien,
- Lisa Howley,
- Yuka Yamamoto,
- Akiko Hirose,
- Terek Motan,
- Venu Jain,
- Winnie Savard and
- Lisa K. Hornberger
Early fetal echocardiography (FE), performed at 12-16 weeks gestational age (GA), can be used to screen for fetal heart disease akin to that routinely done in the mid trimester. The effectiveness of very early FE prior to 12 weeks GA for cardiac screening is unclear. We sought to evaluate the efficacy of FE in assessing the fetal heart structure from 6-7 weeks GA.
From February 2009 we prospectively recruited pregnant women for first trimester FE for a variety of indications including increased nuchal translucency as well as healthy controls. All had 2 dimensional cardiac imaging combined with color Doppler (CD) assessment. Transabdominal scanning was used in all cases with transvaginal scanning used additionally in most cases prior to the 11th week GA (n=92/107, 86%).
227 pregnancies undergoing first trimester FE were included for review. Mean GA at FE was 10+6 weeks (range 6+1 to 13+6 weeks). Significant improvement in image resolution of the fetal heart was gained with every advancing week of gestation. CD assisted with definition of cardiac anatomy at all gestational ages. A four-chambered heart could be identified in 53% of patients in the 8th week GA (n=10/19), improving to 80% (n=36/45) in the 10th week GA and 98% (n=57/58) in the 11th week GA. Both cardiac outflow tracts were imaged on B mode in the minority from 8+0 to 10+6 weeks GA (n=17/70, 24%) but could be imaged in most from 11+0 to 13+6 weeks GA (n=95/119, 80%). CD imaging improved identification of both the outflow tracts to 64% (n=29/45) in the 10th week GA. Crossing of the great vessels, using CD, could be demonstrated in the majority of cases in the 10th week GA (n=25/45, 51%) and improved to 90% in the 11th week GA. The inferior vena cava (IVC) could be identified on B mode imaging as early as 8 weeks GA (n=1/19, 5%). CD improved visualization of the IVC to over 80% from 10 weeks GA. Pulmonary veins were not visualized until after the 11th week GA.
Very early FE, from as early as 8 weeks GA, can be used to assess cardiac structures. The use of CD increases detection of cardiac structures in early FE significantly. Very early FE can be considered as a diagnostic tool in pregnancies with an elevated risk of congenital heart disease.
Moderated Poster Contributions
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Congenital Cardiology Solutions: Important Considerations
Abstract Category: 13. Congenital Cardiology Solutions: Pediatric
Presentation Number: 1293M-135
- 2013 American College of Cardiology Foundation