Fetal Cardiac Anatomy Research Articles

Fuzzy Attention U-Net Architecture Based Localization and YOLOv5 Detection for Fetal Cardiac Ultrasound Images

The importance of early identification of congenital heart disease is highlighted by the fact that it accounts for around 28% of all congenital abnormalities this is the primary reason why fetus die. The necessity of having a thorough understanding of normal cardiac architecture has been highlighted by the quick advancements in fetal heart imaging techniques that have occurred in recent years. Without this information, it is challenging, even impossible, to distinguish the many manifestations of congenital heart illness. This research suggests an immediate fetal cardiac identification technique employing US pictures with the You Only Look Once v5 (YOLOv5) framework and localization using Fuzzy Attention U-Net (FAU-Net) framework in order to enhance the interpretation of the anatomy of the fetal heart through Ultrasound (US) for precise and instantaneous diagnoses. Localization is accomplished using a FU-Net architecture, which limits the training set to image-level plane labels. This is a crucial component of the proposed study since, for big datasets, it would take too much time to produce bounding box annotations, which are not always captured. The FAU-Net design has been optimized for best performance. The YOLOv5 framework is built to function in real-time and deliver the best results for object identification. With the aid of appropriate fine-tuning, it may function effectively to automatically identify tiny fetal cardiac objects in a fast phase. Depending on how much of a detection overlapped with ground-truth bounding boxes, it was determined if it was a genuine positive or a false positive. This research primarily aids medical professionals in the diagnosis of fetal cardiac anatomy. The efficiency of the outcomes is evaluated using metrics including accuracy, memory, average precision (AP), mean average precision (mAP), and F-measure.

How Automated Techniques Ease Functional Assessment of the Fetal Heart: Applicability of MPI+™ for Direct Quantification of the Modified Myocardial Performance Index.

(1) Objectives: In utero functional cardiac assessments using echocardiography have become increasingly important. The myocardial performance index (MPI, Tei index) is currently used to evaluate fetal cardiac anatomy, hemodynamics and function. An ultrasound examination is highly examiner-dependent, and training is of enormous significance in terms of proper application and subsequent interpretation. Future experts will progressively be guided by applications of artificial intelligence, on whose algorithms prenatal diagnostics will rely on increasingly. The objective of this study was to demonstrate the feasibility of whether less experienced operators might benefit from an automated tool of MPI quantification in the clinical routine. (2) Methods: In this study, a total of 85 unselected, normal, singleton, second- and third-trimester fetuses with normofrequent heart rates were examined by a targeted ultrasound. The modified right ventricular MPI (RV-Mod-MPI) was measured, both by a beginner and an expert. A calculation was performed semiautomatically using a Samsung Hera W10 ultrasound system (MPI+™, Samsung Healthcare, Gangwon-do, South Korea) by taking separate recordings of the right ventricle's in- and outflow using a conventional pulsed-wave Doppler. The measured RV-Mod-MPI values were assigned to gestational age. The data were compared between the beginner and the expert using a Bland-Altman plot to test the agreement between both operators, and the intraclass correlation was calculated. (3) Results: The mean maternal age was 32 years (19 to 42 years), and the mean maternal pre-pregnancy body mass index was 24.85 kg/m2 (ranging from 17.11 to 44.08 kg/m2). The mean gestational age was 24.44 weeks (ranging from 19.29 to 36.43 weeks). The averaged RV-Mod-MPI value of the beginner was 0.513 ± 0.09, and that of the expert was 0.501 ± 0.08. Between the beginner and the expert, the measured RV-Mod-MPI values indicated a similar distribution. The statistical analysis showed a Bland-Altman bias of 0.01136 (95% limits of agreement from -0.1674 to 0.1902). The intraclass correlation coefficient was 0.624 (95% confidence interval from 0.423 to 0.755). (4) Conclusions: For experts as well as for beginners, the RV-Mod-MPI is an excellent diagnostic tool for the assessment of fetal cardiac function. It is a time-saving procedure, offers an intuitive user interface and is easy to learn. There is no additional effort required to measure the RV-Mod-MPI. In times of reduced resources, such assisted systems of fast value acquisition represent clear added value. The establishment of the automated measurement of the RV-Mod-MPI in clinical routine should be the next level in cardiac function assessment.

Prenatal screening and diagnosis of pulmonary artery anomalies.

Congenital pulmonary artery anomalies are rare. Their antenatal diagnosis requires good knowledge of fetal cardiac anatomy because their clinical presentation varies depending on the type and severity of the underlying lesion. Screening of these vascular anomalies can be straightforward in some cases because of significant associated consequences that are detected easily on ultrasound, while other anomalies have considerably less obvious features. There may be an associated genetic syndrome. The aim of this review was to define anomalies of the main pulmonary artery and its branches and to propose, through the identification of suspicious findings during routine antenatal heart examination, an optimal screening method for the pulmonary artery pathway. We propose that pulmonary artery anomalies can be classified antenatally into four types of disorder. Herein we describe 14 cases subgrouped accordingly as: anomalies of the pulmonary valvular region, with stenosis or atresia of the valve (n = 4); conotruncal abnormalities (n = 4); anomalies associated with abnormal origin or course of the pulmonary artery (n = 4); and anomalies associated with abnormal growth of the pulmonary artery and its branches (n = 2). We highlight the need to differentiate the three-vessel view from the three-vessel-and-trachea view when assessing a fetus with a congenital pulmonary artery anomaly. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Deep learning-based real time detection for cardiac objects with fetal ultrasound video

Fetal cardiac anatomical structure interpretation by ultrasound (US) is a key part of prenatal assessment. Unfortunately, the numerous speckles in US video, the small size of fetal cardiac structures, and unfixed fetal positions make manual detection processes difficult. To alleviate such problems, a deep learning model was developed to fully automate the processing of fetal echocardiographs with 2-dimensional cross-sectional images. The weakness of such an approach is that a physician immediately interprets US video with 3-dimensional objects to diagnose patients in clinical practice. To improve fetal cardiac anatomical structure interpretation via US for accurate and real time diagnosis, this paper proposes a real-time fetal cardiac substructure detection using US video with the You Only Look Once (YOLO) framework. In YOLO, an end-to-end neural network makes predictions for cardiac substructure objects, boxes, and class probabilities simultaneously. To achieve reliable performance, 40 fetal echocardiography videos were trained with the new YOLOv7 architecture and fine-tuned to work optimally and run efficiently. We conducted with nine fetal cardiac substructure objects such as the left atrium, right atrium, left ventricle, right ventricle, tricuspid valve, pulmonary valve, mitral valve, aortic valve, and aorta. The results yielded the highest mean average precision of 82.10%, reaching 17 frames per second (FPS) for nine cardiac substructure objects in 0.3 ms. The main finding of our study is that with even a limited number of US videos, YOLOv7 can detect fetal cardiac substructure objects in real-time. Such a network can work efficiently to detect small fetal cardiac objects automatically in a rapid phase with the help of proper fine-tuning. This work mainly assists medical experts in the fetal cardiac anatomy diagnostic process.

Three-Dimensional 3D Ultrasound and Doppler Angiography Imaging in the Prenatal Assessment on Normal and Abnormal Fetal Cardiac Anatomy

Three-Dimensional 3D Ultrasound and Doppler Angiography Imaging in the Prenatal Assessment on Normal and Abnormal Fetal Cardiac Anatomy

Postmortem Micro-CT of Human Fetal Heart-A Systematic Literature Review.

Micro-computed tomography (CT) is a non-invasive alternative to conventional macroscopic dissection for the evaluation of human fetal cardiac anatomy. This paper aims to systematically review the literature regarding the use of micro-CT to examine human fetal hearts, to illustrate its educational and research implications and to explain its possible directions for the future. A systematic literature review was conducted following the PRISMA statement to identify publications concerning micro-CT applications for the isolated human fetal heart. The search strategy identified nine eligible studies. Micro-CT is technically feasible for postmortem examination of the human fetal heart coming from early and late termination of pregnancy. It reaches high diagnostic accuracy, and it seems to perform better than autopsy in small samples or in the case of early termination of pregnancy. Applications derived from micro-CT allow multiple off-time evaluations and interdisciplinary comparisons for educational purposes and research perspectives in biological and bioengineering domains.

Prenatal diagnosis of congenital heart defects: echocardiography.

Congenital heart defects (CHD) are the most common congenital anomaly, and the majority can be diagnosed during prenatal life. Prenatal detection rates remain highly variable, as most CHD occur in low risk pregnancies and therefore depend on the maternal obstetric provider to recognize fetal cardiac abnormality on obstetric screening anatomic ultrasound. Fetuses with abnormal findings on obstetric screening anatomic ultrasound and/or risk factors for cardiac disease should be referred for evaluation with fetal echocardiography. Fetal echocardiography should be performed by specialized sonographers and interpreted by physicians with knowledge of evolving fetal cardiac anatomy and physiology throughout gestation. A fetal echocardiography examination, which can be done from the late first trimester onward, utilizes a standardized and systemic approach to diagnose fetuses with CHD or other forms of primary or secondary cardiac disease. The field of fetal cardiology has advanced past the accurate prenatal diagnosis of simple and complex CHD, as fetal echocardiography enables understanding of dynamic fetal cardiac physiology and consideration of potential fetal/neonatal treatment. The greatest impact of fetal echocardiography remains identification of critical CHD before birth to allow immediate cardiac management after delivery to decrease neonatal morbidity and mortality. Analyzing the severity of abnormal cardiac physiology in various forms of CHD before birth allows the fetal cardiologist to prognosticate effects on the developing fetus, predict risk of postnatal hemodynamic instability, guide delivery planning through multidisciplinary collaboration, and anticipate how the disease will impact the neonate after delivery.

Strategies for diagnosis of fetal right atrium dilation: based on fetal cardiac anatomy and hemodynamics

BackgroundFetal right atrium (RA) dilation is frequently detected in routine screenings while it remains a challenge to clarify the reasons. This study aimed to analyze the cardiac anatomy and hemodynamics of fetal RA dilation and the changes of hemodynamic indexes.MethodsIn the retrospective study, 420 fetuses with RA dilation were included, which were classified into the physiological group (n = 202), volume overload group (n = 142), and the pressure overload group (n = 76). The ratio of right atrium to left atrium (RA/LA) were measured at four-chamber view. Peak velocity of tricuspid regurgitation (VTR) was recorded in each case, if existed.ResultsThe RA/LA ratio in the volume overload group is significantly higher than both the pressure overload group and the physiological group (both P = 0.000) throughout the pregnancy while no difference presents between the pressure overload group and the physiological group (P = 0.694 for 19–31 GW, and P = 0.974 for 32–36 GW, respectively). The VTR in the pressure overload group (3.29 ± 0.58 m/s) is significantly higher than both the volume overload group (1.85 ± 0.45 m/s, P = 0.000) and the physiological group (0.88 ± 0.45 m/s, P = 0.000). The volume overload group shows a significantly higher VTR than the physiological group (P = 0.000). In the volume overload group, the ductal contraction/closure shows a significantly higher VTR than that in the pulmonary valve stenosis/atresia (3.98 ± 0.41 m/s vs. 3.03 ± 0.38 m/s, P = 0.000).ConclusionsA strategy proposed herein is useful to clarify the reasons for RA dilatation by systematically assessing fetal hemodynamics, which may facilitate the sonographers to make an accurate diagnosis of congenital heart disease.

Fetal Echo: Application of Four Chamber View and Additional Views in Obstetrics Anomaly Scan and Third Trimester Low-Risk Pregnancy

This article presents a step-wise process to evaluate fetal cardiac anatomy by the radiologist and the pediatric cardiologist, to become more familiar while assessing the four chamber view including the views for the outflow tracts. The additional views include bicaval view, three-vessel view (3VV), three- vessel trachea view (3VT), and aortic arch view. M-mode, color flow mapping and pulse Doppler ultrasound are useful to evaluate cardiac anatomy and function. If the heart does not look normal, the patient should be referred to dedicated fetal echo centre for detailed evaluation. Ductus venosus Doppler, cardiovascular profile score and visualization of thymus in 3-vessel view have also been described in brief.

Sonographic Evaluation of Fetal Cardiac Anatomy in the Late First Trimester

Objective: Congenital heart defects (CHDs) are the most common cause of infant death in the United States. Severe, complex cardiac anomalies make up approximately half of the cases and carry significant morbidity and mortality. The purpose of this literature review was to define a CHD screening protocol to be used in the first trimester. Methods: Literature was pulled that discussed the impact of color Doppler and spatiotemportal image correlation on image quality, explored the benefits and limitations of early screening, and analyzed the risk of bioeffects to the developing fetus. Results: A simplified cardiac screening protocol has been shown to be a feasible addition to the first trimester nuchal translucency scan. Conclusion: Color Doppler and three-dimensional sonography can be utilized during the first trimester to evaluate the fetal heart for major anomalies between 11 weeks and 13 weeks 6 days. Recommendations for future research and guidance from accrediting bodies are provided.

Hypotelorism

Hypotelorism

Micrognathia

Micrognathia

Fetal Cardiac MRI: A Review of Technical Advancements.

Magnetic resonance imaging (MRI) is an appealing technology for fetal cardiovascular assessment. It can be used to visualize fetal cardiac and vascular anatomy, to quantify fetal blood flow, and to quantify fetal blood oxygen saturation and hematocrit. However, there are practical limitations to the use of conventional MRI for fetal cardiovascular assessment, including the small size and high heart rate of the human fetus, the lack of conventional cardiac gating methods to synchronize data acquisition, and the potential corruption of MRI data due to maternal respiration and unpredictable fetal movements. In this review, we discuss recent technical advances in accelerated imaging, image reconstruction, cardiac gating, and motion compensation that have enabled dynamic MRI of the fetal heart.

Fetal transient tricuspid valve regurgitation: sonographic features and clinical evolution

Purpose To analyze the prevalence, the sonographic features, the clinical evolution and significance of fetal tricuspid valve regurgitation (TR). Study design This is a prospective study. Serial ultrasound examinations were performed at 20–23, at 26–29 and at 30–34 gestational weeks in 675 consecutive singleton pregnancies with fetal normal growth and normal cardiac anatomy. The fetal tricuspid valve regurgitation was classified according to its duration, to the peak of jet maximum velocity and to its maximum spatial extension. A clinical examination and echocardiography were performed in neonates after birth. Results During the first examination (20–23 weeks), 32 cases of tricuspid valve regurgitation were identified. The prevalence of tricuspid regurgitation was 4.74%. The large majority of TR cases were not-holosystolic (87.5%), with a maximum velocity below 2 m/sec (80–130 cm/sec in 84% cases and 180–200 cm/sec in 16% cases) and with a little spatial extension (type I or II in 87.5% cases). Following this hemodynamic phenomenon during the following weeks, we found that it disappeared around 29 weeks in all cases. Conclusions Tricuspid regurgitation observed during the second trimester can be considered a transient and functional hemodynamic phenomenon, without apparent pathological significance.

Fetal XCMR: a numerical phantom for fetal cardiovascular magnetic resonance imaging

BackgroundValidating new techniques for fetal cardiovascular magnetic resonance (CMR) is challenging due to random fetal movement that precludes repeat measurements. Consequently, fetal CMR development has been largely performed using physical phantoms or postnatal volunteers. In this work, we present an open-source simulation designed to aid in the development and validation of new approaches for fetal CMR. Our approach, fetal extended Cardiac-Torso cardiovascular magnetic resonance imaging (Fetal XCMR), builds on established methods for simulating CMR acquisitions but is tailored toward the dynamic physiology of the fetal heart and body. We present comparisons between the Fetal XCMR phantom and data acquired in utero, resulting in image quality, anatomy, tissue signals and contrast.MethodsExisting extended Cardiac-Torso models are modified to create maternal and fetal anatomy, combined according to simulated motion, mapped to CMR contrast, and converted to CMR data. To provide a comparison between the proposed simulation and experimental fetal CMR images acquired in utero, images from a typical scan of a pregnant woman are included and simulated acquisitions were generated using matching CMR parameters, motion and noise levels. Three reconstruction (static, real-time, and CINE), and two motion estimation methods (translational motion, fetal heart rate) from data acquired in transverse, sagittal, coronal, and short-axis planes of the fetal heart were performed to compare to in utero acquisitions and demonstrate feasibility of the proposed simulation framework.ResultsOverall, CMR contrast, morphologies, and relative proportions of the maternal and fetal anatomy are well represented by the Fetal XCMR images when comparing the simulation to static images acquired in utero. Additionally, visualization of maternal respiratory and fetal cardiac motion is comparable between Fetal XCMR and in utero real-time images. Finally, high quality CINE image reconstructions provide excellent delineation of fetal cardiac anatomy and temporal dynamics for both data types.ConclusionThe fetal CMR phantom provides a new method for evaluating fetal CMR acquisition and reconstruction methods by simulating the underlying anatomy and physiology. As the field of fetal CMR continues to grow, new methods will become available and require careful validation. The fetal CMR phantom is therefore a powerful and convenient tool in the continued development of fetal cardiac imaging.

Can Ultrasound in Early Gestation Improve Visualization of Fetal Cardiac Structures in Obese Pregnant Women?

To determine whether ultrasound (US) imaging of obese pregnant women in early gestation improves fetal cardiac visualization. We report a prospective longitudinal trial comparing late first- and early second-trimester US to traditional second-trimester US for fetal cardiac screening in maternal obesity. All study participants received US for fetal cardiac screening at a gestational age of 13 weeks to 15 weeks 6 days using a transvaginal or transabdominal approach (UST1). All patients also underwent a traditional transabdominal examination at 20 to 22 weeks (UST2). If UST2 failed to complete the cardiac visualization, a follow up examination (second UST2) was performed 2 to 4 weeks later. Imaging was considered complete if the visceral situs, 4 chambers, outflow tracts, and 3 vessels were visualized. The completion rates between UST1 and UST2 were the primary outcomes. A power analysis (85%) and sample size calculation (n = 145) were performed. A total of 152 pregnancies met study criteria. Completion rates of cardiac screening were 77% for UST1 and 70% for UST2 (P = .143). This comparison reached statistical significance in patients with a body mass index of greater than 40 kg/m2 (UST1 [69%] versus UST2 [38%]; P = .001). Sixty-two percent of patients with a body mass index of greater than 40 kg/m2 required second UST2. The highest fetal cardiac screening completion rate was achieved when UST1 was combined with UST2 (96.1%). In 1 fetus, congenital heart disease was detected at UST1 and later confirmed. This study represents the largest prospective trial assessing early-gestation US for fetal cardiac screening in the setting of maternal obesity. In obese pregnancies, the addition of early-gestation US to the 20- to 22-week US substantially improves the visualization of fetal cardiac anatomy.

Preliminary Experience Using Motion Compensated CINE Magnetic Resonance Imaging to Visualise Fetal Congenital Heart Disease.

Recent advances in cardiovascular magnetic resonance (CMR) imaging have facilitated CINE imaging of the fetal heart. In this work, a preliminary investigation of the utility of multislice CINE CMR for assessing fetal congenital heart disease is performed and compared with echocardiography. Multislice CINE CMR and echocardiography images were acquired in 25 pregnant women wherein the fetus had a suspected congenital heart defect based on routine obstetric ultrasound. Pathognomonic images were identified for each subject for qualitative comparison of CMR and echocardiography. Quantitative comparison of CMR and echocardiography was then performed by 2 reviewers using a binary scoring of 9 fetal cardiac anatomic features (identifiable/not-identifiable). Pathognomonic images demonstrated the ability of CMR to visualize a variety of congenital heart defects. Overall CMR was able to identify the majority of the 9 assessed fetal cardiac anatomic features (reviewer 1, 7.1±2.1; reviewer 2, 6.7±2.3). Although both reviewers identified more anatomic features with echocardiography (reviewer 1, 7.8±2.3; reviewer 2, 7.5±2.4; P=0.01), combining information from both modalities enabled identification of additional anatomic features across subjects (reviewer 1, 8.4±1.3; reviewer 2, 8.4±1.2). The primary limiting factor for CMR was inadequate coverage of the fetal cardiac anatomy or noncontiguous slices because of gross fetal movement. CINE CMR enables visualization of fetal congenital heart disease. This work demonstrates the potential of CMR for diagnosing congenital heart disease in utero in conjunction with echocardiography during late gestation.

Dynamic MRI of a Large Fetal Cardiac Mass

HomeRadiologyVol. 290, No. 2 PreviousNext Reviews and CommentaryFree AccessImages in RadiologyDynamic MRI of a Large Fetal Cardiac MassChristopher W. Roy, Christopher K. Macgowan Christopher W. Roy, Christopher K. Macgowan Author AffiliationsFrom the Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Vaud, Switzerland (C.W.R.); Department of Medical Biophysics, University of Toronto, Toronto, Canada (C.K.M.); and Division of Translational Medicine, the Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay St, Toronto, ON, Canada M5G 0A4 (C.K.M.).Address correspondence to C.K.M. (e-mail: [email protected]).Christopher W. RoyChristopher K. Macgowan Published Online:Nov 20 2018https://doi.org/10.1148/radiol.2018182025MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In A 29-year-old woman in her 21st week of pregnancy underwent fetal echocardiography, at which the fetus was diagnosed with a giant left ventricular rhabdomyoma in the setting of tuberous sclerosis complex (confirmed by genetic analysis TSC2 mutation at birth) (1,2). The left ventricular outflow tract and ventricular function were difficult to assess due to the size of the mass. As a result, fetal cardiac MRI with a 1.5-T imager was performed at 31 weeks, by using accelerated imaging (compressed sensing), translational motion correction, and data-derived retrospective gating, to produce motion-compensated high-spatial-resolution cine images of the fetal heart (Figure; Movie E1 [online]). Fetal cardiac MRI was used to identify the location of the mass in the left ventricle, confirm the patency of the left ventricular outflow tract, determine the fetal right and left ejection fractions (21% and 36%, respectively), and calculate the volume of the mass (35 mL). These images highlight the complementary role of fetal cardiac MRI in understanding complex fetal cardiac anatomy and function in the setting of an intracardiac mass.Coronal balanced steady-state free precession fetal cardiac MR images depict a large rhabdomyoma (M) in the left ventricle, the right ventricular outflow tract (RVOT, A), left ventricular outflow tract (LVOT, B), a pericardial effusion (P), and liver (L). Intracranial masses were also present on MR images of the brain (not shown).Download as PowerPointOpen in Image Viewer Get the Flash Player to see this video.Movie 1 Multisection multiphase motion-compensated coronal balanced steady-state free precession (bSSFP) cine images of a fetal heart with a giant cardiac rhabdomyoma in the left ventricle.Download Original Video (6.6 MB)Disclosures of Conflicts of Interest: C.W.R. disclosed no relevant relationships. C.K.M. disclosed no relevant relationships.C.K.M. supported by Canadian Institutes of Health Research (PJT 148505).

Screening the second-trimester fetal heart in women with an increased body mass index using three-dimensional volume sweep.

To determine the percentage of fetal cardiac anatomy as detailed in the International Society of Ultrasound in Obstetrics and Gynecology Practice Guidelines on sonographic screening examination of the fetal heart, which can be visualised in women with a body mass index (BMI) >30 kg/m2 using three-dimensional (3D) volume sweeps. 3D volumes of the fetal heart were taken prospectively in 40 fetuses during routine second-trimester fetal anatomy scan. Scans and 3D volume sweeps were performed by two experienced sonographers and two experienced raters interpreted the 3D data. 3D volume acquisitions and post-processing analysis were performed according to the techniques described by Weissmann-Brenner et al. The two raters were able to detect an average of 12.9 and 14.1 of the 16 parameters in the 40 patients. Agreement between raters for the 16 parameters had an average of 80%. Five parameters (stomach, situs, heart occupies a third of thoracic area, majority of heart in the left chest and cardiac axis) were detected by both raters on all patients. The range of agreement was between 40% and 100%. The three-vessel view and bifurcation had agreement <60%. Consistent identification of all views of the fetal heart was not achieved using the simple method described in women with a BMI > 30 kg/m2.

P27.07: Feasibility of basic fetal heart imaging during first trimester

Prospective study to evaluate the feasibility of obtaining standard basic fetal heart images during routine first trimester screening. From January 2010 up to December 2016 (7 years), 4518 pregnant women were examined for the purposes of the 1st trimester analytical sonogram. Singleton pregnancies, after spontaneous conception or as a result of IVF were included. All fetuses were characterised as low risk for congenital heart defects. Mothers' average age was 32.4 years (17-43). Mothers' average BMI was 24.8 (18.1-41). The gestational age during examination was on average 12+5 weeks (11+0-13+6), the CRL 64mm (46-81). Attempts were made to image the four-chamber view, the interventricular septum, the outflow and the cross-over of the great vessels and the transverse imaging of the 3 vessels-trachea in the upper part of the thorax. B-mode and bidirectional colour Doppler flow imaging were used in all cases. All images were reviewed offline and evaluated directly after every examination. Fetuses with well-visualised but atypical images were excluded. The sonographic access was transabdominal (82%; 3705/4518), transvaginal (2%;90/4518) or both (16%;723/4518). A satisfactory imaging of a normal fetal cardiac four-chamber view was achievable in 87% (3930/4518) and of a normal transverse three vessel-trachea view in 83% (3750/4518) of the cases (in 13% / 17% technically not feasible). Overall in both, 4CV- and 3VT-view, satisfactory visualisation was obtained successfully in 79% (3570/4518) of fetuses with typical first trimester heart images. The mean additional duration of the examination was less than four minutes (1.3-8.8) if the fetus was lying in the typical for NT-measurement neutral position. The attempt of an early sonographic imaging of the fetal cardiac anatomy is very important for a timely prenatal diagnosis of major congenital heart diseases. The examination conditions are often difficult and require well-experienced examiners. It is feasible to perform basic fetal heart examination during routine first trimester screening.