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Fetal Cardiac Screening
Author(s) -
Sklansky Mark,
DeVore Greggory R.
Publication year - 2016
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.7863/ultra.15.07021
Subject(s) - medicine , obstetrics and gynaecology , medical school , pediatrics , family medicine , medical education , pregnancy , biology , genetics
ow can we improve at prenatal detection of congenital heart disease (CHD)? Despite worldwide efforts to teach and to train, despite all of technology’s newest bells and whistles and promises, and despite raising the bar with the most recent sets of guidelines for fetal cardiac imaging,1–6 prenatal screening for CHD remains flawed, still commonly missing major forms of CHD. During the last 30 years, important weaknesses of prenatal screening programs have been recognized and addressed; guidelines for fetal cardiac imaging have been revised; and detection rates have improved. Increasing recognition of the importance of evaluating the beating heart (rather than still-frame images)7–9 and of the importance of evaluating the outflow tracts along with the 4-chamber view10–12 has resulted in improved rates of detection and revisions of guidelines.1,2,4,5 Expansion of fetal cardiac screening to include the 3-vessel and trachea view has been suggested as a means to facilitate detection of outflow tract and aortic arch abnormalities, and many have recommended that clips should include sweeps to demonstrate the relationship of one cardiac segment to the next.1 As color flow fetal cardiac imaging has been found to facilitate detection and evaluation of CHD,13–14 guidelines now generally include the routine use of color when performing fetal echocardiography1,3,5 but disagree on the role of color during the fetal cardiac screening examination.1,2,4 Guidelines from the International Society of Ultrasound in Obstetrics and Gynecology, for example, recommend clips and encourage color flow imaging,2 whereas guidelines from the American Institute of Ultrasound in Medicine recommend neither clips nor color flow imaging in low-risk pregnancies.4 Finally, although 3-and 4-dimensional fetal cardiac imaging may ultimately facilitate prenatal detection of CHD,15,16 this technology remains unavailable in many settings and requires further study. Mark Sklansky, MD Department of Pediatrics Mattel Children’s Hospital David Geffen School of Medicine at UCLA UCLA Children’s Heart Center Los Angeles, California USA