Abstract
DOI: 10.5935/1678-9741.20130002The congenital heart diseases (CHD) are the most common major malformations at birth [1], with prevalence ranging from 0.6% to 5% of live births [2]. Despite great efforts and technological advancement of two-dimensional echocardiography (2D) in the past two decades, the accuracy in the detection of CHD at prenatal is between 31% and 96% [3].In 2003, with the development of Spatio-Temporal Image Correlation (STIC), scientists started the use of third and fourth dimension ultrasonography (3D/4D) in fetal cardiac evaluation [4]. The STIC is a software that enables acquiring volumetric fetal heart with its vascular connections, whose images can be evaluated in either multiplanar or rendering modes, or even surface mode, in a static or moving ways (4D) by means of a sequence of cineloop, which simulates a complete cardiac cycle [4]. This software provides an innovation absent in 2D ultrasound, which is the storage volume of the heart for an offline analysis, in other words, in the absence of the patient. Thus, a detailed assessment of the anatomy and the functioning fetal heart is possible without the need to cause major discomfort to pregnant women, a relatively frequent situation when more prolonged ultrasound studies are used. Moreover, the storage allows the sending of volumes to specialized centers through an internet link, strengthening the telemedicine and improving the prenatal period tracking [5].Standardization of volume storage is already a reality, so the investigator responsible for offline analysis has knowledge of the actual position of the heart chambers with respect to the right and left fetal axis to evaluate the presence of possible cardiac isomerisms. Therefore, when the fetus is in cephalic presentation, it should be considered that the heart side corresponds to the fetal side, unlike the pelvic fetuses which stay in opposite sides [6].The gray scale and color Doppler applications are also present in the STIC, used to improve the evaluation of the ventricular outflow tracts, aortic and ductal arches, besides assisting in the location of septal defects [7]. The 3D technology has allowed the development of new techniques known as inversion mode (analysis technique of liquid structures which reverses voxels of gray scale,
Highlights
The gray scale and color Doppler applications are present in the Spatio-Temporal Image Correlation (STIC), used to improve the evaluation of the ventricular outflow tracts, aortic and ductal arches, besides assisting in the location of septal defects [7]
Second Dimension Third Dimension Fourth Dimension Congenital Heart Diseases Spatio-Temporal Image Correlation Tomographic Ultrasound Imaging so anechoic structures such as the heart chambers, lumen vessels, stomach, bladder and renal pelvis, with inversion mode they become echogenic, whereas normally echogenic structures, such as bone, become anechoic) [8] (Figure 1) and B-flow imaging [9]
The inversion mode allows the reconstruction of the cardiac chambers, aortic and ductal arches, and abnormalities of venous connections [8]
Summary
The congenital heart diseases (CHD) are the most common major malformations at birth [1], with prevalence ranging from 0.6% to 5% of live births [2]. In 2003, with the development of Spatio-Temporal Image Correlation (STIC), scientists started the use of third and fourth dimension ultrasonography (3D/4D) in fetal cardiac evaluation [4]. Standardization of volume storage is already a reality, so the investigator responsible for offline analysis has knowledge of the actual position of the heart chambers with respect to the right and left fetal axis to evaluate the presence of possible cardiac isomerisms.
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