Advertisement

Screening Views of the Fetal Heart

  • Lindsey E. HunterEmail author

Abstract

International guidelines have been published describing standard screening views of the fetal heart ensuring a systematic approach is undertaken by all practitioners involved in the prenatal detection of major congenital heart disease (CHD).

This systematic approach involves a series of transverse cuts in a caudal to cranial direction including the cardiac situs, four chamber view, left ventricular outflow tract, right ventricular outflow tract, three vessel view (3VV) and finally the three vessel and trachea (3VT) view. This approach aims to increase the prenatal detection of major forms of CHD using a system which can be incorporated into fetal anomaly screening programs.

Keywords

Fetus Fetal heart Screening Prenatal diagnosis Four chamber view Left ventricular outflow tract Right ventricular outflow tract Three vessel view 

Supplementary material

Video 2.1

Tilting the transducer from the fetal head towards the abdomen, establishing the fetal lie within the maternal abdomen (MP4 1464 kb)

Video 2.2

Transverse cut through the fetal abdomen, with a single rib visualised. Descending aorta anterior to the left of the spine, inferior vena cava (IVC) anterior and to the right of the descending aorta. Stomach in the left of the fetal abdomen (AVI 18523 kb)

Video 2.3

Balanced four chamber view, cardiac apex to the left. The left and right ventricles are of similar size. The mitral and tricuspid valves open freely. The heart size is normal (AVI 18407 kb)

Video 2.4

Tilting the transducer cranially from the four chamber view to demonstrate the left ventricular outflow tract (LVOT). The LVOT arises from the centre of the heart and courses towards the right shoulder. The aortic valve is seen to open freely and there is continuity of the interventricular septum and LVOT (AVI 18417 kb)

Video 2.5

Right ventricular outflow tract arising anteriorly, close to the chest wall, continuing straight back towards the spine as the main pulmonary artery and then the arterial duct. The pulmonary valve opens freely with no restriction. The ascending aorta and superior vena cava are seen in cross section to the right of the ductal arch (AVI 16923 kb)

Video 2.6

Tilting the probe cranially from the 3VV, the aorta sweeps to the left of the trachea to meet the arterial duct forming a ‘V’ shape’. The transverse aortic arch to the aortic isthmus is of normal calibre (AVI 20697 kb)

Video 2.7

This four chamber view video shows the moderator band in the apex of the right ventricle. The foramen ovale and foramen ovale flap are well visualised (WMV 3317 kb)

Video 2.8

This sonographic view illustrates the main pulmonary artery bifurcating into the right pulmonary artery and duct. A small cranial angulation switches the view to a three vessel and trachea (3VT) view (AVI 16312 kb)

Video 2.9

This view shows the branching of the main pulmonary artery into left and right pulmonary arteries, just below the level of the arterial duct (WMV 4428 kb)

Video 2.10

This view shows the sweep between the view of the left ventricular outflow tract which heads towards the right shoulder of the fetus and the branching main pulmonary artery which has an anteroposterior orientation (WMV 2700 kb)

Video 2.11

This is a sonographic sweep from the four chamber view to the three vessel and trachea view. With practice, the normal screening views can be obtained by a caudal to cranial smooth sweep through the fetal abdomen and thorax (MP4 1927 kb)

References

  1. Allan L, Dangel J, Fesslova V, Marrek J, Mellander M, Oberhansli I, Oberhoffer R, Sharland G, Simpson J, Sonesson SE. Recommendations for the practice of fetal cardiology in Europe. Cardiol Young. 2004;14(1):109–14.CrossRefGoogle Scholar
  2. Carvalho JS, Allan LD, Chaoui R, Copel JA, Devore GR, Hecher K, Lee W, Munoz H, Paladini D, Tutschek B, Yagel S. ISUOG Practice Guidelines: sonographic screening examination of the fetal heart. Ultrasound Obstet Gynecol. 2013;41(3):348–59.CrossRefGoogle Scholar
  3. Chubb H, Simpson J. The use of z scores in paediatric cardiology. Ann Pediatr Cardiol. 2012;5(2):179–84.CrossRefGoogle Scholar
  4. Fetal Anomaly Screening Programme, United Kingdom. https://www.gov.uk/government/publications/fetal-anomaly-screening-programme-handbook. Accessed 29 July 2017.
  5. Fetal Echocardiography Task Force. AIUM practice guideline for the performance of fetal echocardiography. J Ultrasound Med. 2011;30(1):127–36.CrossRefGoogle Scholar
  6. Hunter LE, Simpson JM. Prenatal screening for structural congenital heart disease. Nat Rev Cardiol. 2014;11(6):323–34.CrossRefGoogle Scholar
  7. Pasquini L, Mellander M, Seale A, Matsui H, Roughton M, Ho SY, Gardiner HM. Z scores of the fetal aortic isthmus and duct: an aid to assessing arch hypoplasia. Ultrasound Obstet Gynecol. 2007;29(6):628–33.CrossRefGoogle Scholar
  8. Rychik J, Ayres N, Cuneo B, Gotteiner N, Hornberger L, Spevak P, Van Der Vel M. American Society of Echocardiography guidelines and standards for performance of the fetal echocardiogram. J Am Soc Echocardiogr. 2004;17(7):803–10.CrossRefGoogle Scholar
  9. Schneider C, McCrindle BW, Carvalho JS, Hornberger LK, McCarthy KP, Daubeney PE. Development of Z-scores for fetal cardiac dimensions from echocardiography. Ultrasound Obstet Gynecol. 2005;26(6):599–605.CrossRefGoogle Scholar
  10. Vigneswaran TV, Akolekar R, Syngelaki A, Charakida M, Allan LD, Nicolaides KH, Zidere V, Simpson JM. Reference ranges for the size of the fetal cardiac outflow tracts from 13 to 36 weeks gestation: a single-center study of over 7000 cases. Circ Cardiovasc Imaging. 2018;11(7):e007575.  https://doi.org/10.1161/CIRCIMAGING.118.007575.
  11. Yagel S, Cohen SM, Achiron R. Examination of the fetal heart by five short axis views: a proposed screening method for comprehensive cardiac evaluation. Ultrasound Obstet Gynecol. 2001;17(5):367–9.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Royal Hospital for ChildrenGlasgowUK

Personalised recommendations