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Early Fetal Echo Detects Most Cardiac Lesions : The technique has limitations, so reserve early echocardiography for cases at the greatest risk.


 

RENO, NEV. — Fetal echocardiography before 16 weeks of gestation is feasible and can detect a substantial proportion of cardiac lesions, investigators reported in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

The technique does have limitations regarding accurate visualization of the great artery relationship and the crux of the heart. It may therefore be best to reserve early echocardiography for cases at the greatest risk for cardiac defects, as judged by increased nuchal translucency and the presence of extracardiac lesions. Second-trimester echocardiograms remain the gold standard, concluded Fionnuala McAuliffe, M.D., of University College Dublin (Ireland) and colleagues.

The study involved 160 fetal echocardiograms performed before the 16th week, with an average gestation time of 13.5 weeks. Investigators used the transabdominal approach for 100 cases, and the transvaginal approach in 60 cases in which the transabdominal approach yielded poor visualization.

Of the 160 patients, 100 were referred because of nuchal translucency greater than the 95th percentile, 51 because of a family history of congenital cardiac defects, and 9 because of the presence of extracardiac lesions.

Adequate cardiac examinations were possible in 152 cases, and pregnancy outcome was available in 137 cases. Of those, there were 20 cardiac defects. Fourteen (70%) showed an abnormality on the early echocardiogram, and 6 (30%) were passed as normal.

The early echocardiogram identified two cases of ectopia cordis, two cases of atrioventricular septal defect, two cases of hypoplastic left heart syndrome, two cases of ventricular septal defect, two cases of left atrial isomerism, two cases of hypoplastic right ventricle, and one case each of double outlet right ventricle and cardiac diverticulum.

On the other hand, the early echocardiogram failed to detect three cases of ventricular septal defect, two cases of dextro-looped transposition of the great arteries, and one case of hypertrophic cardiomyopathy.

A four-chamber view of the heart was obtained in all of the cases. The atrioventricular valves could be visualized 96% of the time, the aorta and pulmonary artery 95% of the time, and the inferior and superior vena cava 76% of the time.

Early fetal echocardiography was less effective in visualizing the aortic and ductal arches (45% of the time), branch pulmonary arteries (37% of the time), and pulmonary veins (19% of the time).

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