Qualitative real-time cross-sectional echocardiographic imaging of the human fetus during the second half of pregnancy

Abstract

In this study, we used high-resolution echocardiographic systems to investigate how early in pregnancy normal fetal cardiac anatomy could be noninvasively evaluated. Over a 2-year period, 84 of 88 fetuses were successfully imaged (27 were studied serially). Postnatal images of 73 were obtained during the newborn period. Estimated fetal age varied at initial examination from 19-41 weeks (mean +/- 0.5 weeks [+/- SEM]) of pregnancy. Estimated fetal weight using an ultrasound algorithm varied from 500-3100 g (mean 1580 +/- 80 g [+/- SEM]). To evaluate fetal cardiac anatomy, we reproduced commonly used cross-sectional views of the heart. The four-chamber and the short-axis great artery views have been most successful for cardiac evaluation in the fetus. These views could be obtained in 96% and 95% of the patients, respectively. With these views, cardiac chamber and valve structures, as well as two great arteries, could be imaged in detail. The ascending and descending aorta, as well as the aortic arch and vessels to the arms and head, were visualized in 87% of examinations, and the inferior and superior venae cavae were visualized in 76%. In two of three RH fetuses, changes in cardiac chambers compatible with hydrops fetalis were demonstrated. We examined all fetuses after birth and verified clinically (or noninvasively) that no cardiac malformations were present. It appears, however, that the diagnosis of major congenital heart defects should be possible before birth.