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      Prenatal ultrasonography and Doppler sonography for the clinical investigation of isolated ventricular septal defects in a late second-trimester population

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          Abstract

          Background

          The purpose of this study was to evaluate the efficacy of prenatal ultrasonography and Doppler sonography in detecting isolated ventricular septal defects (VSDs) in a late-second-trimester population.

          Methods

          Fetal echocardiography, Doppler ultrasound, and biometry were used to evaluate 2,661 singleton fetuses (1,381 male fetuses and 1,280 female fetuses) between 1 August 2006 and 31 May 2010. The efficacy of each fetal biometry, Doppler ultrasound, and nasal bone length (NBL) measurement was evaluated in all of the fetuses. A standard fetal echocardiographic evaluation, including two-dimensional gray-scale imaging and color and Doppler color flow mapping, was performed on all fetuses.

          Results

          We detected isolated VSDs in 124 of the 2,661 singleton fetuses between 19 and 24 weeks of gestation. The prevalence of isolated VSDs in the study population was 4.66%. A multiple logistic regression analysis indicated that short fetal NBL (odds ratio = 0.691, 95% confidence interval: 0.551 to 0.868) and the pulsatility index (PI) of the umbilical artery (odds ratio = 8.095, 95% confidence interval: 4.309 to 15.207) and of the middle cerebral artery (odds ratio = 0.254, 95% confidence interval: 0.120 to 0.538) are significantly associated with isolated VSDs.

          Conclusion

          Late-second-trimester fetal NBL, umbilical artery PI, and middle cerebral artery PI are useful parameters for detecting isolated VSDs, and can be used to estimate the a priori risk of VSDs in women at high risk and at low risk of isolated VSDs.

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          Most cited references34

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          The incidence of congenital heart disease.

          Julien Hoffman, Samuel Kaplan (2002)
          This study was designed to determine the reasons for the variability of the incidence of congenital heart disease (CHD), estimate its true value and provide data about the incidence of specific major forms of CHD. The incidence of CHD in different studies varies from about 4/1,000 to 50/1,000 live births. The relative frequency of different major forms of CHD also differs greatly from study to study. In addition, another 20/1,000 live births have bicuspid aortic valves, isolated anomalous lobar pulmonary veins or a silent patent ductus arteriosus. The incidences reported in 62 studies published after 1955 were examined. Attention was paid to the ways in which the studies were conducted, with special reference to the increased use of echocardiography in the neonatal nursery. The total incidence of CHD was related to the relative frequency of ventricular septal defects (VSDs), the most common type of CHD. The incidences of individual major forms of CHD were determined from 44 studies. The incidence of CHD depends primarily on the number of small VSDs included in the series, and this number in turn depends upon how early the diagnosis is made. If major forms of CHD are stratified into trivial, moderate and severe categories, the variation in incidence depends mainly on the number of trivial lesions included. The incidence of moderate and severe forms of CHD is about 6/1,000 live births (19/1,000 live births if the potentially serious bicuspid aortic valve is included), and of all forms increases to 75/1,000 live births if tiny muscular VSDs present at birth and other trivial lesions are included. Given the causes of variation, there is no evidence for differences in incidence in different countries or times.
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            Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses.

            Meredith Berry, F. Rahman, R. Vazquez Gomez … (2000)
            Invasive techniques such as amniocentesis and cordocentesis are used for diagnosis and treatment in fetuses at risk for anemia due to maternal red-cell alloimmunization. The purpose of our study was to determine the value of noninvasive measurements of the velocity of blood flow in the fetal middle cerebral artery for the diagnosis of fetal anemia. We measured the hemoglobin concentration in blood obtained by cordocentesis and also the peak velocity of systolic blood flow in the middle cerebral artery in 111 fetuses at risk for anemia due to maternal red-cell alloimmunization. Peak systolic velocity was measured by Doppler velocimetry. To identify the fetuses with anemia, the hemoglobin values of those at risk were compared with the values in 265 normal fetuses. Fetal hemoglobin concentrations increased with increasing gestational age in the 265 normal fetuses. Among the 111 fetuses at risk for anemia, 41 fetuses did not have anemia; 35 had mild anemia; 4 had moderate anemia; and 31, including 12 with hydrops, had severe anemia. The sensitivity of an increased peak velocity of systolic blood flow in the middle cerebral artery for the prediction of moderate or severe anemia was 100 percent either in the presence or in the absence of hydrops (95 percent confidence interval, 86 to 100 percent for the 23 fetuses without hydrops), with a false positive rate of 12 percent. In fetuses without hydrops that are at risk because of maternal red-cell alloimmunization, moderate and severe anemia can be detected noninvasively by Doppler ultrasonography on the basis of an increase in the peak velocity of systolic blood flow in the middle cerebral artery.
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              American Society of Echocardiography guidelines and standards for performance of the fetal echocardiogram.

              Nancy Ayres, Bettina Cuneo, Lisa Hornberger … (2004)
              Article 0 comments Cited 68 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Eur J Med Res
                Journal ID (iso-abbrev): Eur. J. Med. Res
                Title: European Journal of Medical Research
                Publisher: BioMed Central
                ISSN (Print): 0949-2321
                ISSN (Electronic): 2047-783X
                Publication date Collection: 2014
                Publication date (Electronic): 24 January 2014
                Volume: 19
                Issue: 1
                Page: 3
                Affiliations
                [1 ]Department of Biomedical Imaging and Radiological Sciences, School of Biomedical Science and Engineering, National Yang-Ming University, 112 Taipei, Taiwan
                [2 ]1st Clinical Medical College, Jinan University, 510632 Guangzhou, China
                [3 ]Department of Obstetrics and Gynecology, Chung Shan Hospital, 106 Taipei, Taiwan
                [4 ]Division of Cardiology, Department of Medicine, Cheng-Hsin General Hospital, 112 Taipei, Taiwan
                [5 ]Department of Radiology, Taipei City Hospital, 100 Taipei, Taiwan
                [6 ]Department of Obstetrics and Gynecology, The 3rd Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
                [7 ]Department of Medical Research and Education, Cheng Hsin General Hospital, No. 45, Cheng-Hsin Street, 112 Taipei, Taiwan
                [8 ]Faculty of Public Health, School of Medicine, Fu-Jen Catholic University, 24205 New Taipei City, Taiwan
                Article
                Publisher ID: 2047-783X-19-3
                DOI: 10.1186/2047-783X-19-3
                PMC ID: 3903045
                PubMed ID: 24456562
                SO-VID: cf414098-99f0-4cb3-82c7-99783ed75711
                Copyright © Copyright © 2014 Chiu et al.; licensee BioMed Central Ltd.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 15 June 2013
                Date accepted : 8 January 2014
                Categories
                Subject: Research

                ScienceOpen disciplines: Medicine
                Keywords: ultrasonography,second trimester,ventricular septal defects
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: ultrasonography, second trimester, ventricular septal defects

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