Ultrasound Patterns in the First Trimester Diagnosis of Congenital Heart Disease

Abstract

Congenital heart disease (CHD) is the most common birth defect, with a reported prevalence of 5-12 per 1000 live births. Very recently, the American Institute of Ultrasound in Medicine published a guideline recommending the use of the four-chamber and the three-vessel and trachea views to screen for CHD in the first trimester of pregnancy. Our aim is to present abnormal image patterns that are seen in the four-chamber, three-vessel, and trachea views of the fetal heart in the first trimester and to describe their association with specific CHD types. We used a total of 29 cases of CHD from the archives of Filantropia Hospital and the Maternal and Child Health Institute (INSMC) fetal medicine units. We selected cases with a clear and well-documented diagnosis of the CHD type. We identified a series of repeating color doppler flow patterns seen in the four-chamber, three-vessel, and trachea views of the studied cases. Our observations could be developed into a diagnosis algorithm to orientate the examiner to the most likely type of CHD in individual cases.

Keywords: congenital heart disease; first trimester of pregnancy; four-chamber view; three-vessel and trachea views.

Figure 1

Color doppler flow patterns encountered in the four-chamber view. (A): Normal filling of both ventricles. (B): Filling of both ventricles, but the cardiac axis is abnormally shifted to the left. (C): Common inflow into the ventricles. (D): Filling of both ventricles, but the left ventricle appears smaller. (E): Filling of only one ventricle.

Figure 2

Color doppler flow patterns encountered in the three-vessel and trachea view. (A): Typical V sign with equally sized arms. (B): The vessels forming a U sign around the trachea. (C): V sign with a narrower arm. (D): One vessel with an oblique and curved course. (E): One vessel with a straight course.

Figure 3

Color doppler flow patterns seen in the three-vessel and trachea view in the case of CAT. (A): Pulmonary arteries arising from the vessel. (B): The straight course of the vessel through the mediastinum.

Figure 4

Color doppler flow patterns of the four-chamber, and three-vessel, and trachea views obtained using low and high PRF/WMF doppler settings in a normal 12–13-week fetus. (A): Low PRF/WMF doppler settings allow better visualization of the size and filling of the ventricles in the four-chamber view. (B): High PRF/WMF doppler settings are preferred to verify the distinct filling of the ventricles. (C): Low PRF/WMF doppler settings offer adequate visualization of the ductal and aortic arches. (D): High PRF/WMF doppler settings can impair the visualization of the aorta.