Cardiac anatomy screening: What is the best time for screening in pregnancy

Current Opinion in Obstetrics and Gynecology

Volumn 15, Issue 2, 2003, Pages 143-146

  Allan, Lindsey D ^a  

^a KING S COLLEGE HOSPITAL   (United Kingdom)

Author keywords

Congenital heart disease; Fetal echocardiography; Fetal heart; Nuchal translucency

Indexed keywords

CONGENITAL HEART DISEASE; DIAGNOSTIC IMAGING; ECHOCARDIOGRAPHY; ECHOGRAPHY; FAMILY HISTORY; FETUS ECHOGRAPHY; FETUS HEART; FETUS MALFORMATION; GESTATIONAL AGE; HIGH RISK PATIENT; HUMAN; PERINATAL CARE; PREGNANCY TERMINATION; PRENATAL SCREENING; PRIORITY JOURNAL; REVIEW; THIRD TRIMESTER PREGNANCY;

ECHOCARDIOGRAPHY; FEMALE; GESTATIONAL AGE; HEART DEFECTS, CONGENITAL; HUMANS; PREGNANCY; ULTRASONOGRAPHY, PRENATAL;

EID: 0037386659     PISSN: 1040872X     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001703-200304000-00009     Document Type: Review

References (15)

1. Garne E, Stoll C, Clementi M, Euroscan Group. Evaluation of prenatal diagnosis of congenital heart diseases by ultrasound: experience from 20 European registries. Ultrasound Obstet Gynecol 2001; 17:386-391. A useful study giving an overall view of current scanning practice throughout Europe. Data were drawn from 20 registries of congenital malformations from 12 countries in Europe, with widely varying strategies for ultrasound screening of pregnancy. As might be expected, detection was lowest in those countries with no screening programme, but even in those with screening programmes ostensibly to a similar standard, the detection rate varied between 19 and 48%.
2. Stoll C, Dott B, Alembik Y, De Geeter B. Evaluation and evolution during time of prenatal diagnosis of congenital heart diseases by routine fetal ultrasonographic examination. Ann Genet 2002; 45:21-27. Further useful data from the Eurocat registry. The prenatal diagnosis of congenital heart disease was compared in a well defined population during three time periods, 1979-88, 1989-93 and 1993-99. The detection rate rose from 9.2%, to 13.7%, to 19.1%, respectively. Congenital heart disease was more likely to be detected when there was a gross four-chamber view anomaly or extracardiac malformations were present in association.
3. Yagel S, Weissman A, Rotstein Z, et al. Congenital heart defects: natural course and in utero development. Circulation 1997; 96:550-555.
4. Kohl T, Sharland G, Allan LD, et al. World experience of percutaneous ultrasound-guided balloon valvuloplasty in human fetuses with severe aortic valve obstruction. Am J Cardiol 2000; 85:1230-1233.
5. Mahle WT, Clancy RR, McGaurn SP, et al. Impact of prenatal diagnosis on survival and early neurologic morbidity in neonates with the hypoplastic left heart syndrome. Pediatrics 2001; 107:1277-1282. A careful study of adverse neurological events seen in 216 patients undergoing surgery for the hypoplastic left heart syndrome during the period 1992-97, of whom 79 were diagnosed prenatally. Although the mortality (of 26%) did not differ between the pre and postnatally diagnosed groups, there were fewer adverse neurological events in the prenatally diagnosed group than in the postnatal group. As these events are known to correlate with adverse developmental outcome, it is suggested that prenatal diagnosis should confer a significant long-term benefit.
6. Verheijen PM, Lisowski LA, Stoutenbeek P, et al. Prenatal diagnosis of congenital heart disease affects preoperative acidosis in the newborn patient. J Thorac Cardiovasc Surg 2001; 121:798-803. A retrospective multicentre study of 408 patients requiring surgery for congenital heart disease in the first month of life. The worst blood gases of those 81 prenatally diagnosed were compared with 327 postnatally diagnosed. The postnatally diagnosed group, especially those who were duct dependent, had significantly more severe metabolic acidosis in the preoperative period. As acidosis correlates with long-term developmental delay, this study demonstrates the benefit of prenatal diagnosis.
7. Bonnet D, Coltri A, Butera G, et al. Detection of transposition of the great arteries in fetuses reduces neonatal morbidity and mortality. Circulation 1999; 99:916-918.
8. Vinals F, Tapia J, Giuliano A. Prenatal detection of ductal dependent congenital heart disease: how can things be made easier? Ultrasound Obstet Gynecol 2002; 19:246-249. Successful screening of the heart during routine obstetric scanning provided a valuable contribution to management of the pregnancy with congenital heart disease in this study. Views of the upper thorax were imaged as a routine screen for duct-dependent congenital heart disease. Reverse flow in the duct or arch indicated duct dependency in 5/43 cases of fetal congenital heart disease diagnosed between 21 and 31 weeks of gestation, allowing plans to be made for transferring delivery to a geographically remote site where paediatric cardiology facilities were available.
9. Barboza JM, Dajani NK, Glenn LG, Angtuaco TL. Prenatal diagnosis of congenital cardiac anomalies: a practical approach using two basic views. Radiographics 2002; 22:1125-1137. Adding great artery views to the four-chamber view was found to be practical during routine scanning, increased the detection of congenital heart disease and improved the accuracy of diagnosis.
10. Carvalho JS, Mavrides E, Shinebourne EA, et al. Improving the effectiveness of routine prenatal screening for major congenital heart defects. Heart 2002; 88:387-391. This study showed that adding outflow tract views to the four-chamber evaluation at the routine obstetric scan improved the detection rate of major structural heart disease as would be expected. It was useful to demonstrate that adding the outflow tract views was not difficult or time consuming in practice.
11. Comas Gabriel C, Galindo A, Martinez JM, et al. Early prenatal diagnosis of major cardiac anomalies in a high-risk population. Prenat Diagn 2002; 22:586-593. This is a useful study describing high-risk pregnancies screened echocardiographically between 12 and 17 (mean 14) weeks of gestation. Visualization of the heart was successful in 95% within 30 min, using transabdominal and transvaginal probes. Of the abnormal hearts found at later follow-up or autopsy, 79% were suspected at the initial scan.
12. Carvalho JS. Early prenatal diagnosis of major congenital heart defects. Curr Opin Obstet Gynecol 2001; 13:155-159. This is a review of the drive towards early diagnosis of cardiac malformations during pregnancy. This drive is fuelled by improvements in technology and the increasing detection of the special high-risk group of fetuses with increased nuchal translucency. A caution is offered concerning the awareness of evolution of cardiac malformations later in pregnancy, indicating that later scans should not be abandoned if the heart appears normal before 16 weeks of gestation.
13. Hyett J, Perdu M, Sharland G, et al. Using fetal nuchal translucency to screen for major congenital cardiac defects at 10-14 weeks of gestation: population based cohort study. BMJ 1999; 318:81-85.
14. Ghi T, Huggon IC, Zosmer N, Nicolaides KH. Incidence of major structural cardiac defects associated with increased nuchal translucency but normal karyotype. Ultrasound Obstet Gynecol 2001; 18:610-614. An impressively large series of over 1000 fetuses with nuchal translucency over the 95th candle and normal chromosomes were examined echocardiographically for congenital heart disease. Overall, the disease occurred in 4.5%. The rate was 2.5% in those with a nuchal translucency measurement between 2.5 and 3.4 mm and 7% in those with a measurement of 3.5 mm or more. This risk of congenital heart disease is substantially higher than the commonly recognized high-risk groups, such as those with diabetes or a family history of the disease, emphasizing the importance of screening this group.
15. Huggon IC, Ghi T, Cook AC, et al. Fetal cardiac abnormalities identified prior to 14 weeks' gestation. Ultrasound Obstet Gynecol 2002; 20:22-29. Of nearly 500 fetuses undergoing fetal echocardiography between 11 and 14 weeks of gestation, diagnostic images were obtained transabdominally in 84% of cases. There were abnormal cardiac findings in over 100 fetuses. There was an abnormal karyotype in 25% of those with normal heart findings and in 73% of those with abnormal cardiac findings. Although there were some false negatives and some false positives, as well as additions to the diagnosis in some of the abnormal cases, in general, there was good correlation between the early findings and follow-up. An attempt at diagnosis of the cardiac anatomy is feasible therefore at the time of detection of increased nuchal translucency. Although this was essentially a learning experience in early scanning for this group, the results and the numbers are impressive.