Screening performance of congenital heart defects in first trimester using simple cardiac scan, nuchal translucency, abnormal ductus venosus blood flow and tricuspid regurgitation

Congenit Heart Dis. 2019 Nov;14(6):1094-1101. doi: 10.1111/chd.12852. Epub 2019 Oct 1.

Abstract

Objective: The objective of this study was to analyze if the addition of simple cardiac scan in cases with increased nuchal translucency (NT) and/or abnormal ductus venosus (DV) blood flow, and/or tricuspid regurgitation (TCR) can improve detection of congenital heart defects (CHD) in chromosomally normal fetuses without non-cardiac defects at 11-13 + 6 gestational weeks in a population of singleton pregnancies.

Methods: During the 10 years period, all singleton pregnancies at 11-13 + 6 weeks were routinely scanned for NT, DV blood flow and TCR assessment and, if a single of these parameters was abnormal, simple cardiac scan with 2D gray scale and color and/or directional power Doppler in 4-chamber (4-CV) and 3 vessel and trachea views (3VTV) was performed.

Results: The sensitivity and specificity of NT ≥ 95th + DV R/A a-wave + TCR in detecting CHD were 77% and 97%, respectively, and of simple cardiac scan, 67% and 98%, respectively. Area under the curve of receiver operating characteristic curve of NT ≥ 95th + DV R/A a-wave + TCR was 0.838, and of NT ≥ 95th + DV R/A a-wave + TCR + simple cardiac scan was 0.915.

Conclusions: In chromosomally normal fetuses without non-cardiac anomalies, addition of simple cardiac scan to the combined first trimester screening parameters improves detection of major CHD during first trimester.

Keywords: cardiac scan; congenital heart defect; ductus venosus; nuchal translucency thickness; tricuspid regurgitation.

MeSH terms

  • Adult
  • Blood Flow Velocity
  • Echocardiography, Doppler, Color*
  • Female
  • Fetal Heart / abnormalities
  • Fetal Heart / diagnostic imaging*
  • Fetal Heart / physiopathology
  • Heart Defects, Congenital / diagnostic imaging*
  • Heart Defects, Congenital / etiology
  • Heart Defects, Congenital / physiopathology
  • Humans
  • Nuchal Translucency Measurement*
  • Predictive Value of Tests
  • Pregnancy
  • Pregnancy Trimester, First
  • Reproducibility of Results
  • Retrospective Studies
  • Risk Factors
  • Tricuspid Valve Insufficiency / diagnostic imaging*
  • Tricuspid Valve Insufficiency / etiology
  • Tricuspid Valve Insufficiency / physiopathology
  • Ultrasonography, Prenatal*
  • Umbilical Veins / diagnostic imaging*
  • Umbilical Veins / physiopathology