A Practical Approach to Fetal Heart Scanning
Lindsey D. Allan
Evaluation of the fetal heart can be readily incorporated into the obstetric ultrasound examinationand need not add more than a few minutes to the examination. Correct analysis of the four-chamberview and both outflow tracts will exchule the majority of serious congenital heart disease. Wherecardiac malformations are identified during pregnancy, parents should be referred to a pediatriccardiologist with expertise and experience of fetal heart scanning for further counseling. This allowsfor management of the pregnancy to be tailored to the parents wishes and the type of malformationfound.
Copyright 9 2000 by W.B. Saunders Company
ardiac malformations are common, affect-ing about 8 of 1,000 pregnancies. However,only about 3 of 1,000 are serious and readilydetectable prenatally. It is important to detectserious forms of congenital heart disease in thefetus as they are associated with a significantmorbidity and mortality in affected children.All forms of congenital heart disease nowadayscan be treated, although at varying levels ofrisk and quality of outcome. A clear understand-ing in early pregnancy of the prognosis for thechild allows parents to make informed decisionsconcerning the management. In continuingpregnancies, the outcome for the affected childcan be improved by optimizing perinatal man-agement. There are some categories of preg-nancy in which there is an increased risk ofcongenital heart disease and these mothersshould be referred to a fetal echocardiographerfor detailed study. These include mothers with afamily history of congenital heart disease, mater-nal diabetes, exposure to cardiac teratogens inearly pregnancy, and the detection of fetal ar-rhythmias or extracardiac abnormalities. Thislast group include those with extracardiac mal-formations, especially those with nuchal edema,or fetal hydrops. However, 90% of mothers whogive birth to infants with congenital heart dis-ease have no high risk features noted in theirpregnancy. The only hope these patients have of
From the Department of Pediatric Cardiology, New York PresbyterianHospital, New Yark, NY.Address reprint requests to Lindsey D. Allan, MD, FRCP, FACC,Babies Hospital 2N, 3959 Broadway, New York, NY 10032; e-mail:email@example.comCopyright 9 2000 by W.B. Saunders CompanyO146-0005/00/2405-0002510. 00/0doi: 10. 1053/sper. 2000.16551
congenital heart disease being detected is forsomething abnormal being recognised duringthe obstetric scan. For this reason, the conceptof "screening" the fetal heart in a simplifiedfashion during routine obstetric scanning wasintroduced. 1Cardiac assessment during an anatomical ob-stetric survey is recommended to include at leasta four-chamber view of the heart, 2 and this sin-gle view will detect about 60% of serious malfor-mations or abnormalities in about 2 of 1,000pregnancies scanned. Despite the fact that al-most all pregnancies are scanned at some timeduring gestation and that the four-chamber viewshould be part of every ultrasound assessment,many forms of congenital heart disease recogni-sable in this view continue to be overlookedduring obstetric evaluation/Many authors havesuggested a more detailed study be performedduring obstetric evaluation to increase the de-tection of congenital heart disease by includingidentification of the great artery connections. 4Accurate evaluation of the great arteries connec-tions will detect up to 90% of serious cardiacmalformations.
For the perinatologist the following aspects ofcardiac structure or function should be estab-lished: (1) The heart lies on the left side of thefetus, on the same side as the stomach; (2) Thefour-chamber view is normal; (3) The ventriculo-arterial connections are normal; and (4) Thearch and duct are normal.324
Seminars in Perinatology,
Vol 24, No 5 (October), 2000: pp 324-330