The importance of four-chamber and three-vessel (3-V) views in the screening of fetal cardiac anomalies in the first trimester

Objective: In this study, we aimed to investigate the efficiency of first trimester fetal heart examination. Methods: This study was carried out prospectively on the pregnant women admitted for the screening of first trimester chromosomal anomaly to the perinatology clinic between August 2016 and February 2018. The cardiac examination was performed by obtaining abdominal situs screening and the four-chamber and three-vessel (3-V) views. The cases found to have cardiac anomaly were followed up. The patient data and results were recorded. Descriptive statistical analyses were performed. Results: A total of 707 fetuses in 693 pregnancy cases were exam- ined in this study. While the fetal heart examinations were performed by the transabdominal ultrasonography in 661 cases, the necessary images could not be obtained in the examinations of 32 (4.6%) cases, and the assessment was done by transvaginal ultra- sonography. Abnormal cardiac findings were found in 10 cases. The diagnosis could not be validated in 3 cases and they were considered having normal hearts, and the false positivity was found in 0.4% (3/698) of the cases. The aneurysm of restrictive foramen ovale was found in two cases whose first trimester examinations were considered normal. The sensitivity, specificity, positive predictive value and negative predictive value of four-chamber and three-vessel (3-V) image for detecting the cardiac anomalies in the first trimester heart examination were 77%, 99.5%, 70% and 99.7%, respectively. Conclusion: A great number of cardiac anomalies can be diagnosed by four-chamber and three-vessel (3-V) cross-sections in the first trimester. Also, it should be kept in mind that there may be false pos- itivity and false negativity in the first trimester heart examinations even with low rates and some cardiac anomalies can be seen or detect- ed only in the further weeks of gestation, and the families should be informed accordingly.

[1]  K. Nicolaides,et al.  Value of routine ultrasound examination at 35–37 weeks' gestation in diagnosis of fetal abnormalities , 2020, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[2]  K. Nicolaides,et al.  Diagnosis of fetal non‐chromosomal abnormalities on routine ultrasound examination at 11–13 weeks' gestation , 2019, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[3]  A. Ebrashy,et al.  Fetal heart examination at the time of 13 weeks scan: a 5 years’ prospective study , 2019, Journal of perinatal medicine.

[4]  J. Arenas Ramírez,et al.  Early fetal ultrasound screening for major congenital heart defects without Doppler. , 2019, European journal of obstetrics, gynecology, and reproductive biology.

[5]  Yuka Yamamoto,et al.  First‐Trimester Fetal Echocardiography: Identification of Cardiac Structures for Screening from 6 to 13 Weeks' Gestational Age , 2017, Journal of the American Society of Echocardiography.

[6]  G. Rembouskos,et al.  The three‐vessel and trachea view (3VTV) in the first trimester of pregnancy: an additional tool in screening for congenital heart defects (CHD) in an unselected population , 2017, Prenatal diagnosis.

[7]  A. Knafel,et al.  Prenatal Detection of Congenital Heart Defects at the 11‐ to 13‐Week Scan Using a Simple Color Doppler Protocol Including the 4‐Chamber and 3‐Vessel and Trachea Views , 2015, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[8]  F. Orlandi,et al.  Simplified first‐trimester fetal cardiac screening (four chamber view and ventricular outflow tracts) in a low‐risk population , 2014, Prenatal diagnosis.

[9]  G. Rembouskos,et al.  Fetal cardiac evaluation at 11–14 weeks by experienced obstetricians in a low‐risk population , 2011, Prenatal diagnosis.

[10]  K. Nicolaides,et al.  Fetal echocardiography at 11–13 weeks by transabdominal high‐frequency ultrasound , 2011, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[11]  Kypros H Nicolaides,et al.  Screening for fetal aneuploidies at 11 to 13 weeks , 2011, Prenatal diagnosis.

[12]  K. Nicolaides,et al.  Challenges in the diagnosis of fetal non‐chromosomal abnormalities at 11–13 weeks , 2011, Prenatal diagnosis.

[13]  Z. Weiner,et al.  Fetal cardiac scanning performed immediately following an abnormal nuchal translucency examination , 2008, Prenatal diagnosis.

[14]  J. Hoffman,et al.  Incidence of congenital heart disease: II. Prenatal incidence , 1995, Pediatric Cardiology.