RECOMMENDED VIEWS FOR FETAL ECHOCARDIOGRAPHY

WHY SCREEN FOR CARDIAC ANOMALIES?

· Cardiac anomalies are the most common congenital malformations.

o Incidence of fetal cardiac malformations = 8:1000 live-births.

o Incidence of major congenital heart disease = 3-4:1000 live-births.

· Incidence of cardiac malformations are 6.5 times more common than chromosomal anomalies.

· Incidence of cardiac malformations are 4 times more common than neural tube defects.

· Most infants (up to 80%) with cardiac malformations are born to mothers with no known risk factors (low risk patient). There prenatal detection is dependent on sensitive prenatal screening protocols.

· Major congenital heart disease may be defined as complex structural malformations of the heart and great vessels that requires surgical or catheter intervention within the first 6 months to twelve months of life.

· 20-25% of neonatal deaths are attributable to congenital abnormalities (up to 50% of theses infants have cardiac disease).

· There is therefore convincing evidence that fetal echocardiography should be routinely included in every scan. Antenatal detection impacts: Further management; parental counseling (amniocentesis, outcome etc); planning obstetrical and neonatal care (especially in the presence of ductus dependent lesions).

We suggest that a routine fetal echocardiogram should employ five transverse (axial) images and two sagittal images.

TRANSVERSE (AXIAL) VIEWS

A1 – Transverse (axial) view through the upper abdomen.

A2 – Traditional four-chamber view of the heart (apical and subcostal views).

A3 – Aortic and pulmonary outflow tracts.

A4 – Pulmonary artery bifurcation.

A5 – Three-vessel view.

Video clip of the five axial views of the heart

SAGITTAL VIEWS

S1 – Ductal arch.

S2 – Aortic arch.

Video clip of Aortic and Ductal Arches - Sagittal plane