Abstract
BackgroundThe diagnosis of congenital heart defects is challenging, especially for what concerns conotruncal anomalies. Indeed, although the screening techniques of fetal cardiac anomalies have greatly improved, the detection rate of conotruncal anomalies still remains low due to the fact that they are associated with a normal four-chamber view. Therefore, the study aimed to compare real-time three-dimensional echocardiography with live xPlane imaging with two-dimensional (2D) traditional imaging in visualizing ductal and aortic arches during routine echocardiography of the second trimester of gestation.MethodsThis was an observational prospective study including 114 women with uncomplicated, singleton pregnancies. All sonographic studies were performed by two different operators, of them 60 by a first level operator, while 54 by a second level operator. A subanalysis was run in order to evaluate the feasibility and the time needed for the two procedures according to fetal spine position and operator’s experience.ResultsThe measurements with 2D ultrasound were performed in all 114 echocardiographies, while live xPlane imaging was feasible in the 78% of the cases, and this was mainly due to fetal position. The time lapse needed to visualize aortic and ductal arches was significantly lower when using 2D ultrasound compared to live xPlane imaging (29.56 ± 28.5 s vs. 42.5 ± 38.1 s, P = 0.006 for aortic arch; 22.14 ± 17.8 s vs. 37.1 ± 33.8 s, P = 0.001 for ductal arch), also when performing a subanalysis according to operators’ experience (P < 0.05 for all comparisons). Feasibility of live xPlane proved to be correlated with the position of the fetal spine and the operator’s experience.DiscussionTo find a reproducible and standardized method to detect fetal heart defects may bring a great benefit for both patients and operators. In this scenario live xPlane imaging is a novel method to visualize ductal and aortic arches. We found that the position of the fetal spine may affect the feasibility of the method since, when the fetal back is anterior or transverse, the visualization of the correct view of three-vessels and trachea in order to set the reference line properly becomes more challenging. In addition, the fetal spine position influences the duration of the ultrasound examination. Regarding operator’s skills and experience, in our study a first level operator was able to perform the complete 2D and xPlane examination in a lower number of cases compared to second level operators. In addition, the time required for the complete examination was higher for first level operators. This means that this technique is based on an adequate operators’ expertise.
Highlights
The objective of the present study was to evaluate to feasibility of real-time 3D echocardiography with live xPlane imaging compared to two-dimensional (2D) traditional imaging in visualizing ductal and aortic arches, analyzing the potential impact of factors influencing the feasibility of the technique, such as position of the fetal spine and operator’s experience and skills
The visualization rate of the aortic arch and ductal arch with 2D ultrasound was performed in all 114 cases (100%), while the examination was completed in 89 cases (78.1%) using live xPlane imaging, of them with aortic arch examination (80.7%) and ending with ductal arch examination (81.5%) (Table 1)
The timing with 2D ultrasound was significantly lower compared to live xPlane imaging starting from the four-chamber view until visualization of either aortic (29.56 ± 28.5 s vs. 42.5 ± 38.1 s, P = 0.006) as well as ductal arch (22.14 ± 17.8 s vs. 37.1 ± 33.8 s, P = 0.001)
Summary
Congenital heart defects (CHDs) are the most common form of congenital anatomical anomaly (Rocha et al, 2013).They are associated with high morbidity and mortality rates, and their incidence is estimated to be 4–13 per 1,000 live births (Galindo et al, 2009; Sivanandam et al, 2006).Antenatal screening offers a number of advantages such as establishing a strategy for peripartum management and screening for co-existing abnormalities, eventually allowing intrauterine intervention in some cases (Franklin et al, 2002).the diagnosis of CHDs is challenging, especially for what concerns conotruncal anomalies. The screening techniques of fetal cardiac anomalies have greatly improved, the detection rate of conotruncal anomalies still remains low due to the fact that they are associated with a normal four-chamber view (Paladini et al, 1996; Sivanandam et al, 2006; Tometzki et al, 1999). The time lapse needed to visualize aortic and ductal arches was significantly lower when using 2D ultrasound compared to live xPlane imaging (29.56 ± 28.5 s vs 42.5 ± 38.1 s, P = 0.006 for aortic arch; 22.14 ± 17.8 s vs 37.1 ± 33.8 s, P = 0.001 for ductal arch), when performing a subanalysis according to operators’ experience (P < 0.05 for all comparisons). Discussion: To find a reproducible and standardized method to detect fetal heart defects may bring a great benefit for both patients and operators In this scenario live xPlane imaging is a novel method to visualize ductal and aortic arches. Regarding operator’s skills and experience, in our study a first level operator was able to perform the complete 2D and xPlane
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
