Abstract
The examination of very small fetal hearts requires special equipment and a specialist that are not available in many general pathology laboratories. Compared to conventional examination, the four-chamber cardiac dissection (4CCD) method can be performed by any pathologist using instruments generally available in pathology services. The aim of this study is to evaluate the efficiency of the 4CCD method in the examination of small fetal hearts using post-mortem magnetic resonance imaging (pm-MRI) at 7T as the standard. Twelve fetuses with gestational ages between 13 and 19 weeks have been included in this study. All fetuses underwent pm-MRI examination prior to pathologic examination. The 4CCD method was used for the cardiac examination in all cases following the same guidelines for cardiac sectioning. The 4CCD was able to identify all cardiac anatomic structures as compared to pm-MRI at 7T, demonstrating a sensibility of 95.8% (95% CI, 94.5–95.8) and specificity of 100% (95% CI, 32.3–100). The overall accuracy in identifying cardiac anatomic structures was 95.8% (95% CI, 93.4–95.8). Additionally, the 4CCD method was able to detect cardiac anomalies with an overall diagnostic accuracy of 91% (95% CI, 85.8–94.2), sensibility of 67.6% (95% CI, 54.5–75.3), and specificity of 97% (95% CI, 93.7–99) as compared to pm-MRI at 7T. The four-chamber view dissection method can be considered as an alternative to the conventional inflow–outflow dissection method in selected cases.
Highlights
Fetal cardiac examination is an important step in evaluating the presence of malformations during fetal autopsy and may present unique challenges
Considering that conventional 1.5T and 3T magnetic resonance imaging (MRI) magnets currently used in clinical setting have shown lower accuracy in examining fetuses below 16 weeks of gestation [8,9], we considered the use of a high-power field magnet of 7T
The cases comprised in our group had a median gestational age (WG) of 16.5 weeks and mean gestational age of 16.08 weeks ± 2.07SD, with a median fetal weight of 89 g and mean fetal weight of 118.33 g ± 98.52SD, as well as a median fetal heart weight of 1 g and mean fetal heart weight of 1.2 g ± 1.1SD
Summary
Fetal cardiac examination is an important step in evaluating the presence of malformations during fetal autopsy and may present unique challenges. The combination of small-sized organ and complex malformative lesions require expertise, experience, and appropriate medical instruments in order to perform post-mortem examination of the fetal heart. A generally accepted method for cardiac dissection of the fetal heart is the inflow– outflow method. The sections for opening the atria and ventricles follow the course of blood flow through the heart. Another widely used method for cardiac dissection is the short axis method which is the election method for evaluating ischemic heart disease and is mostly used in children and adult patients [2]
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