Prenatal Diagnosis of Congenital Heart Disease: Where Are We Now?
Section snippets
Fetal cardiac screening
Cardiac abnormalities occur with an estimated incidence of approximately 4–13 per 1000 live births [4], [5], [6]. Most of the affected children will be born to mothers with no identifiable risk factors for CHD. Consequently, standardized approaches are needed to screen low-risk populations for cardiac abnormalities.
Prenatal cardiac screening was introduced in the mid-1980s when the four-chamber view of the heart was incorporated into a routine obstetric scan between 18 and 22 weeks, menstrual
What influences the prenatal detection of congenital heart disease?
Several factors affect the quality of a successful fetal cardiac screening program. These factors help to explain why prenatal detection rates have varied so widely in the medical literature.
Chaoui [20] has summarized key reasons as to why the four-chamber view does not always provide an optimal detection rate among various centers. The reasons include inadequate examination, unrecognized abnormalities, evolution of cardiac lesions, and the inability for this view to detect specific anomalies
Fetal cardiac screening guidelines
The primary goal of cardiac screening is to identify which fetuses are likely to have CHD. Current guidelines emphasize a “basic examination” using a satisfactory four-chamber view of the heart. If technically feasible, an “extended basic” examination of the left and right ventricular outflow tracts is also recommended [40], [41], [42]. Fetuses with suspected anomalies should be referred for fetal echocardiography to assess the seriousness of the anomaly and the likelihood of a ductal dependent
Sonographic detection of selected cardiac anomalies
This section summarizes the clinical significance and sonographic findings associated with selected examples of CHD that may be detected by basic and extended basic cardiac screening exam.
Summary
CHD is a leading cause of infant morbidity and mortality that results from birth defects. Diagnosticians who use ultrasonography to evaluate the fetal heart must be familiar with key factors that can impact the success of their cardiac screening programs. A good understanding of practice guidelines for the “basic” and “extended basic” cardiac examination is essential. Efforts should also be made to standardize diagnostic training of these who perform these examinations in an ongoing manner. The
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