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Fetal echocardiography: Accuracy and limitations in a population at high and low risk for heart defects

  • Author Footnotes
    a From the Department of Obstetrics and Gynecology, Brigham and Women's Hospital
    Bryann Bromley
    Correspondence
    Reprint requests: Bryann Bromley, MD, Diagnostic Ultrasound Associates, 333 Longwood Ave., Boston, MA 02115.
    Footnotes
    a From the Department of Obstetrics and Gynecology, Brigham and Women's Hospital
    Affiliations
    Boston, Massachusetts
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  • Author Footnotes
    b Department of Radiology, Brigham and Women's Hospital
    ,
    Author Footnotes
    c Department of Newborn Medicine, Brigham and Women's Hospital
    Judy A. Estroff
    Footnotes
    b Department of Radiology, Brigham and Women's Hospital
    c Department of Newborn Medicine, Brigham and Women's Hospital
    Affiliations
    Boston, Massachusetts
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  • Author Footnotes
    g Department of Cardiology, Children's Hospital, Harvard Medical School.
    Stephen P. Sanders
    Footnotes
    g Department of Cardiology, Children's Hospital, Harvard Medical School.
    Affiliations
    Boston, Massachusetts
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  • Author Footnotes
    e the Department of Radiology, Children's Hospital, Harvard Medical School.
    ,
    Author Footnotes
    f Department of Pediatrics, Children's Hospital, Harvard Medical School.
    Richard Parad
    Footnotes
    e the Department of Radiology, Children's Hospital, Harvard Medical School.
    f Department of Pediatrics, Children's Hospital, Harvard Medical School.
    Affiliations
    Boston, Massachusetts
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  • Author Footnotes
    d Department of Pathology, Brigham and Women's Hospital
    Drucilla Roberts
    Footnotes
    d Department of Pathology, Brigham and Women's Hospital
    Affiliations
    Boston, Massachusetts
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  • Author Footnotes
    a From the Department of Obstetrics and Gynecology, Brigham and Women's Hospital
    Fredric D. Frigoletto Jr
    Footnotes
    a From the Department of Obstetrics and Gynecology, Brigham and Women's Hospital
    Affiliations
    Boston, Massachusetts
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  • Author Footnotes
    a From the Department of Obstetrics and Gynecology, Brigham and Women's Hospital
    ,
    Author Footnotes
    b Department of Radiology, Brigham and Women's Hospital
    Beryl R. Benacerraf
    Footnotes
    a From the Department of Obstetrics and Gynecology, Brigham and Women's Hospital
    b Department of Radiology, Brigham and Women's Hospital
    Affiliations
    Boston, Massachusetts
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  • Author Footnotes
    a From the Department of Obstetrics and Gynecology, Brigham and Women's Hospital
    b Department of Radiology, Brigham and Women's Hospital
    c Department of Newborn Medicine, Brigham and Women's Hospital
    d Department of Pathology, Brigham and Women's Hospital
    e the Department of Radiology, Children's Hospital, Harvard Medical School.
    f Department of Pediatrics, Children's Hospital, Harvard Medical School.
    g Department of Cardiology, Children's Hospital, Harvard Medical School.
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      Objective: Our objective was to assess the accuracy of prenatal echocardiography in detecting congenital heart defects in patients at high and low risk for structural cardiac anomalies.
      Study design: Sixty-nine consecutive fetuses with congenital heart defects who had had prenatal ultrasonography at ≥18 weeks' gestation were evaluated to determine the accuracy of prenatal ultrasonography in identifying structural cardiac defects. Thirty-nine patients were at high risk and 30 patients were at low risk for cardiac anomalies. All fetuses were scanned with standard four-chamber and outflow tract views. Data concerning extracardiac anomalies and karyotypic abnormalities were tabulated. The accuracy of the four-chamber view alone in identifying congenital heart defects was evaluated.
      Results: Fifty-seven of 69 fetuses (83%) were prenatally identified ultrasonographically as having a heart defect. There was no difference in the sensitivity of detecting cardiac anomalies between high-risk and low-risk groups. When the four-chamber view was used, only 63% of fetuses were recognized as having an abnormal heart. Extracardiac anomalies were noted in 36% and karyotypic abnormalities in 17% of patients.
      Conclusion: The four-chamber and outflow tract views done routinely in an ultrasonography laboratory seeing a mixed population of patients was successful in detecting 83% of fetuses with structural cardiac malformations. Because 43% of the fetuses with heart defects were referred for low-risk indications, systematic ultrasonographic examination of the fetal heart should not be reserved only for those at high risk.

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