First trimester fetal echocardiography limitations and its expected clinical values


Kamel H, Yehia A.
Egypt Heart J. 2020 Apr 7;72(1):16. doi: 10.1186/s43044-020-00049-1.
PMID: 32266496 Free PMC Article
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Background: Fetal cardiac activity could be observed between 6th and 7th gestational weeks, early performance of fetal echocardiography could be implemented to screen for fetal heart disease. The effectiveness of early first trimester fetal echocardiography has not been adequately investigated, especially with modern sonographic technological advances. The purpose of the study is to evaluate the capability to visualize fetal cardiac structures within the first trimester as early as 10th gestational weeks and to elucidate the value of using color Doppler in visualization of cardiac structures within early gestation. A prospective clinical trial conducted on 150 study subjects, 44 of them were twin gestations. Cases were fully assessed by fetal echocardiographic examination from 10th gestational week to 13 gestational weeks in a sequential manner weekly. The research study was conducted at cardiology department fetal unit in one of the tertiary hospitals.

Results: Four chamber view was mostly visualized from 12 gestational weeks, whereas cardiac axis was fully visualized in all cases from 12 gestational weeks; on the other hand, IVC assessment by 2D was satisfactorily visualized in 78.26% of cases and by color Doppler in 82.61% of cases at 13 gestational weeks, pulmonary veins were visualized in 21.74% of cases by 2D and 43.5% of cases by color Doppler at 13 gestational weeks, and interestingly, ventricular inflows were satisfactorily visualized in almost all cases from 10th gestational weeks.

Conclusions: First trimester fetal echo is an outstanding enhancement in management pathways of cases susceptible to have fetal cardiac abnormalities permitting early detection of structural cardiac anomalies triggering a cascade of scanning for extra cardiac anomalies to aid in evaluation and assessment of the best management course for those affected cases.


Conflict of interest statement

The authors declare that they have no competing interests.

Fig. 1
Four chamber view both by 2D and color Doppler imaging in a case 12-week gestation

Fig. 2
a Shows left ventricle outflow tract view by 2D imaging in a case 13-week gestation. b Shows right ventricle outflow tract by both 2D and color Doppler imaging in a case 11-week gestation

Fig. 3
Normal systemic veno-atrial connection by both 2D and color Doppler imaging in a case 12-week gestation

Fig. 4
2D imaging of the aortic arch in a case 13-week gestation