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Abnormal fetal cardiac axis in the detection of intrathoracic anomalies and congenital heart disease
Author(s) -
Crane J. M.,
Ash K.,
Fink N.,
Desjardins C.
Publication year - 1997
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1046/j.1469-0705.1997.10020090.x
Subject(s) - medicine , fetus , fetal echocardiography , heart disease , autopsy , ultrasound , cardiology , gestational age , obstetrics and gynaecology , pregnancy , radiology , prenatal diagnosis , genetics , biology
In a 14‐month period, 409 women with singleton gestations referred for perinatal ultrasound consultation underwent evaluation of the fetal cardiac axis. Cardiac and intrathoracic anomalies were confirmed either by neonatal echocardiography or autopsy. Overall, 32 fetuses had an abnormal axis (nine, smaller axis than normal; 23, larger axis than normal). Of the 29 found to have cardiac ( n = 24) or intrathoracic ( n = 5) anomalies, 23 had an abnormal axis. The median cardiac axis of the normal group (44.0°) was significantly smaller than that of the cardiac/intrathoracic anomaly group (60.0°) ( p = 0.002). The cardiac axis was independent of gestational age. The mean interobserver variation was 1.3 ± 1.8°. The sensitivity of an abnormal axis (< 28° or > 59°) in detecting congenital heart disease or intrathoracic anomalies was 23/29 (79.3%), with specificity of 371/380 (97.5%), positive predictive value of 23/32 (71.9%), and negative predictive value of 371/377 (98.4%). Of those with a cardiac anomaly and an abnormal axis ( n = 18), five were felt to have an initial normal four‐chamber view. An abnormal fetal cardiac axis, either larger or smaller than normal, is suggestive of a cardiac or intrathoracic anomaly and requires further investigation, such as fetal echocardiography. The cardiac axis should be considered with the four‐chamber view in fetal ultrasound evaluation. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology