3D Fetal Echocardiography Research Articles

Fetal MRI and prenatal diagnosis of congenital heart defects

Fetal MRI and prenatal diagnosis of congenital heart defects

Prenatal diagnosis of total anomalous pulmonary venous connection by 2D and 3D fetal echocardiography.

Prenatal diagnosis of total anomalous pulmonary venous connection (TAPVC) by fetal echocardiography (FE) remains a challenge. We sought to ascertain the diagnostic accuracy of 2D and 3D spatiotemporal image correlation (STIC) FE and the potential incremental value of 3D STIC FE for prenatal diagnosis and assessment of TAPVC. This study was conducted retrospectively in a single tertiary referral center. The study population consisted of 74 TAPVC from 17063 fetuses by FE from August 2010 to April 2016. The 3D volume acquisition was also performed by STIC. A total of 17063 fetal echocardiograms in our institution were queried and 74 (0.4%) were identified with TAPVC. In the TAPVC group, 11 had postnatal echocardiographic study, 25 had autopsies, 36 declined autopsy and 2 lost for follow-up. The sensitivity of FE for diagnosis of TAPVC was 97.14%, specificity 99.98%, respectively. In our cohort, 31 fetuses were evaluated by both 2D and 3D STIC and were confirmed by postnatal echocardiography or autopsies. TAPVC was diagnosed in all 31 patients (100%) by both 2D FE and 3D STIC. Furthermore, the classification of subtypes of TAPVC and accurate diagnosis of the drainage pathway was correct in 26 (83.9%) and 24 (77.4%) cases by 2D FE, respectively; but in 31 (100%) and 31 (100%) cases by 3D STIC. 2D and 3D STIC FE provide accurate diagnosis of TAPVC with excellent sensitivity and specificity. 3D STIC FE has incremental value in further evaluation of classification of TAPVC types and drainage pathways.

HDlive Image of Fetal Endocardial Cushion Defect

ABSTRACT We present our first experience of constructing an image of a fetal endocardial cushion defect (ECD) employing HDlive at 21 weeks and 3 days of gestation. Conventional two-dimensional (2D) echocardiography showed an atrioventricular septal defect, bilateral ventricular hypertrophy and massive pericardial effusion. Two-dimensional color Doppler ultrasound revealed atrioventricular valve regurgitation in systole. HDlive clearly demonstrated a glossy atrial septal defect, common atrioventricular valve and bilateral ventricular hypertrophy. Moreover, free, floating leaflets of the common atrioventricular valve not attached to the interventricular septum were suspected using HDlive. These findings suggested complete ECD with congestive heart failure. HDlive provided us with a new, realistic, and arguably much improved view of the complexities and interrelationships of intracardiac structures in a case of fetal ECD. HDlive may assist in the evaluation of fetal EDC, and offer potential advantages relative to conventional 2D fetal echocardiography. How to cite this article AboEllail MAM, Hanaoka U, Mashima M, Kawanishi K, Hata T. HDlive Image of Fetal Endocardial Cushion Defect. Donald School J Ultrasound Obstet Gynecol 2014;8(4):437-439.

Three‐dimensional fetal echocardiography for prediction of postnatal surgical approach in double outlet right ventricle: a pilot study

To examine the feasibility of reconstructing three-dimensional (3D) echocardiographic views in fetuses with double outlet right ventricle, which might enhance prognostication with respect to the postnatal surgical approach. This was a retrospective blinded observational study. Our database was reviewed from January 2007 to June 2011 to identify fetuses with usual atrial arrangement, concordant atrioventricular connections, double outlet right ventricle and relatively balanced left and right ventricular size. Six fetuses, in which there was an intention to treat, were included. In all six cases, we identified important features, including location of the ventricular septal defect and its relation to the atrioventricular valves and great arteries. The postnatal surgical approach was predicted accurately in each case. In this group of fetuses with double outlet right ventricle, detailed evaluation by 3D fetal echocardiography enhanced visualization of the anatomy, leading to accurate prediction of the type of surgical repair. Prospective validation in a large cohort of fetuses is warranted.

Three‐dimensional sonography in the prenatal diagnosis of aortic arch abnormalities

To assess the added value of 3-dimensional (3D) echocardiography with spatiotemporal image correlation (STIC) in the diagnosis of aortic arch abnormalities in fetuses with isolated abnormal upper thoracic 3-vessel view (3VV). A total of 3,420 women underwent a targeted anatomic survey at 18-22 weeks' gestation in a 1-year period. An isolated abnormal upper thoracic 3VV detected on 2-dimensional (2D) imaging was followed up by conventional 2D echocardiography and 3D fetal echocardiography with STIC. Offline reconstruction by a second operator blinded to the suspected diagnosis was performed. Neonatal echocardiography and MRI with 3D reconstruction were performed to verify the prenatal diagnosis. Of the 3,420 patients referred, 4 had an isolated abnormal 3VV (0.09%). A right-sided aortic arch (RAA, n = 3) and double aortic arch (DAA, n = 1) were suspected. In all aortic arch abnormalities, 3D fetal echocardiography and STIC correctly identified RAA with aberrant left subclavian artery in 3 cases and DAA in 1 case with a degree of definition that was equal to the confirmatory postnatal echocardiography and 3D MRI. Although the 2D upper 3VV is a powerful screening tool for isolated aortic arch abnormalities, 3D fetal echocardiography with STIC allows an accurate prenatal characterization of the abnormality to a degree that is typically attainable only by post partum imaging.

Spatio‐temporal image correlation (STIC) used by general obstetricians is marginally clinically effective compared to 2D fetal echocardiography scanning by experts

To assess the effectiveness of spatio-temporal image correlation (STIC) used by general obstetricians as compared with 2D scanning. As many as 30 pregnant women at 17-21 weeks' gestation were enrolled. 2D ultrasound was performed by a fetal echocardiologist; STIC was performed by a general obstetrician. Time, accuracy of measurement of diameter of great vessels and quality of the pictures obtained by the two methods were compared. The mean time required by 2D ultrasound was significantly shorter than that by STIC (5.2 +/- 1.9 min vs 9.8 +/- 2.7 min; P < 0.001). The measurement of the diameter of the great vessels showed some difference but the mean score of the pictures obtained by both methods were not significantly different. By using 2D ultrasound, acceptable quality pictures were obtained in 51.9, 44.4 and 51.9% of cases for 4-chamber, 5-chamber and 3-vessel views, respectively. Meanwhile by using STIC, the percentages were 77.8, 59.3 and 37%. Our study suggested that STIC used by general obstetricians to check normality of fetal cardiac structures at 17-21 weeks' gestation has marginal clinical effectiveness when compared to 2D scanning by a fetal echocardiologist, and should need some improvement before it can be used as a tool to expand a fetal cardiac screening program.

Real‐time three‐dimensional color Doppler fetal echocardiographic features of congenital heart disease

The purpose of this report is to describe the real-time three-dimensional (3D) color Doppler fetal echocardiographic findings of congenital heart diseases. Two cases of fetal congenital heart disease were diagnosed antenatally by conventional two-dimensional fetal echocardiography and real-time 3D color Doppler fetal echocardiography. Conventional two-dimensional (2D) fetal echocardiography showed a hypoplastic left heart in one case, and a double-outlet right ventricle in the second case. Real-time 3D fetal echocardiography with instantaneous volume-rendered displays showed surgeon's eye views of intracardiac abnormal cardiac structures of the beating heart in both cases. Real-time 3D color Doppler fetal echocardiography depicted a subtle tricuspid regurgitant jet in hypoplastic left heart syndrome, and great arteries, left from the right ventricle, in parallel in a double-outlet right ventricle. Real-time 3D color Doppler fetal echocardiography may assist in the evaluation of fetal cardiac anatomy and hemodynamics, and offer the potential advantages relative to conventional 2D fetal echocardiography and Doppler flow mapping.

OP08.13: Frequency of and causes of ventricular disproportion in fetal echocardiograms

Objectives: To evaluate the performance of 3D software that allows retrieving standard diagnostic planes of the fetal heart from a 3D volume and estimate inter-observer reproducibility of fetal cardiac views in the second trimester of pregnancy. Methods: 73 fetal cardiac volumes were acquired in pregnant women between 20–32 weeks of gestation using Accuvix XQ (MEDISON, Korea). Seven diagnostic planes of the fetal heart, according to standardization of 3D fetal echocardiography: 4-CH view, LVOT, RVOT, 3 vessel view, aortic & ductal arches, venous connection (SVC & IVC) have been retrieved from 3D volumes of the fetal chest using software 3D XI PC Viewer that is composed of Multi-Slice View (MSV) and Oblique View (OBV) modes. The off-line fetal cardiac study was performed by 2 specialists not involved in the volume acquisition, with similar skills in 2D fetal cardiac scanning, but different degree of skills in 3D US examination. 4-CH view was set as an acquisition plane. 25–35 degree of volume sweep was appropriate to capture the stomach and upper mediastinum levels. Results: In our study identification rate and reproducibility of main cardiac landmarks, such as LVOT, RVOT and 3 vessels view were substantial. However, the visualization rate and reproducibility of diagnostic planes of the fetal heart not included into the ‘basic’ 2D cardiac ultrasound, such as ductal arch and venous connection, were lower in less experienced in 3D US hands (Observer 1).

Real‐time 3‐dimensional echocardiographic features of fetal cardiac tumor

We present a case of fetal cardiac tumors diagnosed using conventional 2-dimensional (2D) fetal echocardiography and real-time 3-dimensional (3D) echocardiography. Conventional 2D echocardiography revealed multiple cardiac tumors involving the right atrium, interventricular septum, and right and left ventricles. Real-time 3D echocardiography with instantaneous volume rendering showed the cardiac tumors in motion. The advantages and disadvantages of real-time 3D fetal echocardiography are discussed.

Modern 3D/4D sonographic studies on fetal heart

We present herein modern three-dimensional (3D)/four-dimensional (4D) sonographic studies on fetal heart using 4D or real-time 3D fetal echocardiography, 3D/4D color/power Doppler ultrasound and 3D/4D high definition (HD)-flow, 3D/4D B-flow, and 3D/4D inversion mode. 3D/4D ultrasound provides a novel means for evaluation of fetal heart in 3D in real time, and of fetal intracardiac hemodynamics in the second and third trimesters. These novel techniques may assist in the evaluation of fetal cardiac anatomy and hemodynamics, and offer the potential advantages relative to conventional two-dimensional fetal echocardiography and Doppler flow mapping. 3D/4D ultrasound may be an important modality in future fetal cardiac research and in evaluation of congenital heart disease in the fetus.

Modern 3D/4D sonographic studies on fetal heart

AbstractWe present herein modern three-dimensional (3D)/four-dimensional (4D) sonographic studies on fetal heart using 4D or real-time 3D fetal echocardiography, 3D/4D color/power Doppler ultrasound and 3D/4D high definition (HD)-flow, 3D/4D B-flow, and 3D/4D inversion mode. 3D/4D ultrasound provides a novel means for evaluation of fetal heart in 3D in real time, and of fetal intracardiac hemodynamics in the second and third trimesters. These novel techniques may assist in the evaluation of fetal cardiac anatomy and hemodynamics, and offer the potential advantages relative to conventional two-dimensional fetal echocardiography and Doppler flow mapping. 3D/4D ultrasound may be an important modality in future fetal cardiac research and in evaluation of congenital heart disease in the fetus.

OC5.07: Comparison of 3D power Doppler ultrasound (3D‐PDU) versus 3D with Inversion mode rendering in 3D fetal echocardiography

3D-PDU is an established technique in the assessment of the fetal cardiovascular system. The new “inversion mode (IM) rendering” enables without the use of Doppler to “invert” the hypoechoic informations in the volume box to a solid-like structure. We aimed to compared the accuracy of both techniques in 3D fetal echocardiography. 25 normal fetuses and 15 fetuses with various cardiac anomalies were examined between 20–30 weeks with both techniques. Presets were adapted individually according to the visualization conditions. Volumes were acquired in 3D static or in STIC (off-line 4D) technique. (GE-Voluson 730 Expert System). The evaluation was performed on an using the 4D-View software. Basic image quality was better with gray scale with a high image frame rate (80–110 Hz), vs PDU with slow rate (12–32 Hz). Time for presets optimisation was shorter for gray-scale in comparison to PDU image. Although on normal and abnormal hearts both techniques were similar in visualizing the heart and great vessels, this was easier and more accurately achieved using IM. IM was furthermore superior in visualizing tiny cardiac vessels in malformations, especially in unfavourable position. Power Doppler was superior in the demonstration of very small vessels and flow not seen on 2D as e.g. pulmonary veins, aberrant aortic arch vessels, muscular VSD or tricuspid regurgitation. Limitation of PDU was the overlapping of flow information, whereas the limitation of IM were the artefacts caused from shadowing (ribs, spine). The relationship to other thoracic structures was only possible in 3D-PDU glass body mode. 3D-IM technique is an easy accessible tool in 3D fetal echo. In regions with tiny vessels or in cases with hemodynamic events, power Doppler can be a complementary technique. The difficult preset optimisation and the low frame rates are still the main limitations of 3D-PDU.

A New Approach to Fetal Echocardiography

The purpose of this study was to describe a method of 4-dimensional (4D) reconstruction of the cardiac chambers and outflow tracts using a combination of spatiotemporal image correlation, "inversion mode," and "B-flow" imaging. Spatiotemporal image correlation and the inversion mode were used in the examination of the volume data sets of 23 fetuses with congenital heart anomalies. A subset was also examined with B-flow imaging using the gradient light algorithm. Digital reconstructions from abnormal hearts were compared with a library obtained from fetuses without abnormalities. Rendered images of the 4-chamber view using the inversion mode were characterized by: (1) echogenic chambers; (2) sharp delineation of chamber contours when compared with 2-dimensional (2D) images; and (3) distinct display of the myocardium, interventricular septum, interatrial septum, and mitral and tricuspid valves as anechoic structures. Ventricular septal defects, abnormal differential insertion of the atrioventricular valves, and valve atresia were well visualized with the inversion mode. The application of inversion mode or B-flow imaging to 4D rendering of the outflow tracts resulted in "digital casts" displaying the spatial relationships between the outflow tracts as well as the connections between the great arteries and ventricular chambers. The spatial relationships and communications among cardiac structures cannot be visualized with conventional 2D ultrasonography. The application of spatiotemporal image correlation, inversion mode, and B-flow imaging generates information about the anatomy and pathologic characteristics of the fetal heart (digital casts) that cannot be obtained with 2D fetal echocardiography. We propose that these modalities enhance the information provided by ultrasonographic interrogation of the fetal heart and will improve prenatal diagnosis.

Dynamic free-hand three-dimensional fetal echocardiography gated by cardiotocography.

To evaluate the clinical feasibility of conventional cardiotocography (CTG) as a cardiac cycle triggering signal for three-dimensional (3D) fetal echocardiography. Free-hand 3D echocardiography was performed on a total of 25 fetuses with and without congenital heart disease at various gestational ages (mean, 29 weeks; range, 19-35 weeks). Simultaneously, online CTG was used for time gating. Gray-scale and color Doppler dynamic 3D displays, as well as multiplanar views, were assessed for their ability to depict the cardiac morphology and correct cardiac gating. Valid CTG-based trigger signals could be obtained in 24 of the 25 fetuses. Correct cardiac gating was achieved in 101 of the 111 (91%) 3D datasets. Color Doppler imaging of blood flow in four dimensions was possible in 34 of 36 (94%) datasets. Reconstructed 3D and multiplanar views provided additional views not available in two-dimensional (2D) imaging. Acoustic interference between the CTG transducer and echotransducer could be reduced by the use of a high-frequency echotransducer, second-harmonic frequency imaging and appropriate positioning of the two transducers. Imaging quality was highly dependent on the quality of 2D images and random motion artifacts. CTG can be used as an online gating source for dynamic 3D fetal echocardiography.

Real time 3D sonography of the normal fetal heart--clinical evaluation

Aim of the study was to determine the clinical feasibility of real time 3D ultrasound in the examination of the normal fetal heart compared to conventional 2D fetal echocardiography. Twenty fetuses with normal hearts at 20 to 38 weeks of gestation underwent real time 3D ultrasound. Examination data were stored on an external notebook. Later analysis and interpretation was done by a different sonographer using a special software. In the assessment of the four chamber view and the out flow tracts real time 3D ultrasound was equivalent to conventional ultrasound. Advantages of realtime 3D ultrasound were the possibility of later time-independent off-line analysis and post-processing of volume data and generation of new views not available in 2D imaging. Disadvantages included low frame rate (16 frames/s), low lateral resolution and the lack of Doppler and colour information. Simultaneous display of 3 different views of the fetal heart as well as the construction of spatial perspectives ("new views") provide additional useful information to conventional fetal echocardiography. Later off-line analysis of 3D volume data can be used for sequential analysis of the normal fetal heart with good diagnostic results. Currently it remains unclear whether this new method may provide additional important information in the assessment of fetal congenital heart defects.

Dreidimensionale fetale Echokardiographie - Aktueller Stand und künftige Perspektiven1

The purpose of echocardiographic imaging in the fetus is to provide clear representations of the underlying cardiac anatomy. Studies on pre- and postnatal 3D echocardiography have shown this technique can provide an alternative form of image display for comprehensive assessment of congenital heart disease. To date, several different methods are used for 3D echocardiography in the fetus. The technique used at our institution is analogous to the 3D technology employed in studies on neonates and children and uses an electromagnetic location device to register transducer position during data acquisition. As it derives from a complex assembly of sequentially acquired two-dimensional images this technique has important limitations due to fetal movement artifacts and difficulties in cardiac gating. Despite good three-dimensional appreciation of some anatomical detail, this often results in inadequate image quality when compared with 2D echocardiography. Potential advantages of 3D fetal echocardiography include the following: the ability to slice the acquired 3D volume data into an infinite number of two-dimensional cross-sections, and the ability to reconstruct unique three-dimensional views not seen with two-dimensional imaging. However, considering the limitations and the time needed for 3D image processing its practical clinical relevance in the antenatal situation is still not clear. Ongoing research should be aimed toward improved image resolution and applying this new technique to more immediate "on-line" analysis of 3D reconstructions.

3D Real-Time Imaging of the Fetal Heart

Objective: The aim of this study was to evaluate the clinical utility of a novel 3D scanner system for real-time 3D fetal echocardiography. Method: In a prospective study, 13 single, healthy 20- to 24-week-old fetuses were examined with conventional 2D and real-time 3D echocardiography. The visualization rates and imaging quality of standard cardiac views were compared between both methods. Results: The visualization rates of standard cardiac planes were found to be slightly increased and more easily obtainable in 3D imaging whereas the image quality showed better results with conventional 2D echocardiography. Conclusion: Our data show that real-time 3D fetal echocardiography can be considered a useful tool in the evaluation of the fetal heart with the necessity for further refinement of the resolution quality