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Cited by 45Congenital Heart Disease StudiesPrenatal Screening and DiagnosticsCongenital heart defects research

Guidelines for fetal echocardiography

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Satomi, Gengi·2015·Pediatrics International
DOI 10.1111/ped.12467
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Abstract

of Pediatric Cardiology and Cardiac Surgery Congenital heart defects have been reported to occur in 1 out of every 100 births but, because this statistic does not include miscarriages or stillbirths, it can be inferred that the actual number of fetuses with heart defects is almost fivefold greater than that reported.1 Approximately one-third of such patients have serious heart defects, which is the major cause of infant mortality.These congenital defects, however, are the most difficult to diagnose prenatally.Screening for heart defects is performed in only a low percentage of cases. 2 In addition, 90% of heart defects occur in low-risk infants with no clear indication of a congenital anomaly on prenatal examination.3,4 Goals Prenatal diagnosis of congenital heart disease is common throughout the world.Improved survival rates, fewer complications, and lower medical costs are characteristic of centers where prenatal screening for heart defects is performed.Prenatal screening of congenital heart disease is rapidly becoming more commonplace in Japan, but at present it is limited in accuracy and efficacy.According to reports from the UK, prenatal screening for congenital heart disease varies widely from region to region.In and around areas such as London, however, many physicians are extremely proactive in the use of prenatal screening for congenital heart disease.5 These guidelines are intended to establish a standardized protocol for prenatal diagnosis of congenital heart disease in Japan.Obstacles to the realization of a comprehensive prenatal screening program for congenital heart defects in Japan include problems related to the installation of equipment, lack of knowledge about congenital heart disease, technical problems with fetal echocardiography, notification of parents about the diagnosis, emotional care for the family, and ethical problems.These guidelines address these issues, but they do not include the use of transvaginal probes for fetal echocardiography. EffectivenessReports from Japan and throughout the world discuss the advantages and disadvantages of prenatal screening using fetal echocardiography.Some reports conclude that prenatal screening does not offer many advantages with respect to the incidence of congenital heart defects.6,7 This study takes issue with this viewpoint, asserting that prenatal screening offers many benefits to patients and their families.Hypoplastic left heart syndrome, one of the most severe types of congenital heart defects, provides a good example of the effectiveness of prenatal diagnosis.In undiagnosed cases left to follow the natural course, infants die of shock as a result of closure of the arterial duct within 1 week of birth.When oxygen is given for cyanosis, it triggers closure of the arterial duct, thus worsening the situation.In a study by Satomi et al., among the infants for whom prenatal screening was performed, no oxygen was given, no shock was observed, and the infants were immediately transferred to a facility where surgery could be performed between 1 and 15 days after birth (average, 7 days).In contrast, among 10 infants for whom no prenatal screening was performed, four (40%) suffered shock and two (20%) required oxygen between 1 and 10 days (average, 3 days) before they were transferred to a facility where surgery could be performed.Surgery was performed between 9 and 24 days (average: 19 days) after birth.Therefore, health status was lower for infants in this latter group.In contrast, health status was better for infants in the group that underwent prenatal screening and early surgery.Satomi et al. concluded that prenatal screening contributed to improved outcome in cases of congenital heart defects.8 Tworetzky et al. compared 33 cases of congenital heart defects diagnosed prenatally with 55 diagnosed postnatally in terms of the effect on surgical outcome.They found that the postoperative survival rate of infants in the prenatal diagnosis

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  • By referring to the thoracic wall, examiners recognize the relative orientation and size of structures inside the thorax, which allows the detection of congenital abnormalities.

    “By referring to the thoracic wall, examiners ensure that the obtained 4CV is in the appropriate cross-section [11], and then recognize the relative orientation and size of structures inside the thorax, which allows the detection of congenital abnormalities [12,13].”

    From Model-Agnostic Method for Thoracic Wall Segmentation in Fetal Ultrasound Videos (2020) · cites this paper as [13]

  • Cardiac axis and position, determined by the orientation and location of the heart relative to the thoracic wall, can trigger the detection of fetal abnormalities.

    “cardiac axis and position, determined by the orientation and location of the heart relative to the thoracic wall, can trigger the detection of fetal abnormalities [12,13].”

    From Model-Agnostic Method for Thoracic Wall Segmentation in Fetal Ultrasound Videos (2020) · cites this paper as [13]

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  1. J. Am. Coll. Cardiol. 1996; 28: 1805-9.
  2. Satomi G, Yasukochi S, Iwasaki Y et al. Standardization and advantages of fetal echocardiography. In: Imai Y, Momma K (eds). Proceedings of the Second World Congress of Pediatric Cardiol- ogy and Cardiac Surgery. Futura, New York, 1998; 618-19.
  3. Maeno Y. Diagnosis and therapy of fetal arrhythmias. In: Kato H (ed). Pediatric Echocardiography. From Basics to Current Clinical Applications. Kanahara Press, Tokyo, 1993; 54-9 (in Japanese).
  4. Allan LD. Fetal arrhythmias. In: Long WA (ed). Fetal and Neona- tal Cardiology. WB Saunders, Philadelphia, PA, 1990; 180-96.
  5. Maeno Y. Pharmacological treatment of fetal arrhythmias. In: Sugishita Y, Momma K, Yazak Y et al (eds). Annual Review in Cardiology 2002. Chugai Igaku-sha, Tokyo, 2002; 176-81 (in Japanese).
  6. Fetal echocardiography. In: Feigenbaum H (ed). Echocardiogra- phy (Chapter 7. Congenital Heart Disease), 5th edn. Lea & Febiger, PA, 1994; 431-2.

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Authors
Satomi, G.
Affiliations
Nagano Children's Hospital (JP)
Corresponding author
Satomi, Gengi
Venue
Pediatrics International
Publisher
Wiley
Published
2015-02
Volume
57
Issue
1
Pages
1-21
ISSN
  • 1328-8067 (ISSN-L)
  • 1442-200X
DOI
10.1111/ped.12467
OpenAlex
W1551049356
Cited by
44
References
76
Citations by year
2026: 1 · 2025: 2 · 2024: 1 · 2023: 5 · 2022: 4 · 2021: 15 · 2020: 6 · 2019: 3 · 2018: 2 · 2017: 3 · 2016: 2
FWCI
1.83
Type
journal article
Language
en
Open access
Licence
Locations
  • Pediatrics International (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
Soochow University
Topics
  • Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Screening and Diagnostics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Congenital heart defects research
Keywords
fetal echocardiography, prenatal diagnosis, congenital heart disease, prenatal screening, hypoplastic left heart syndrome, parental notification, family support, ethical considerations, Japan, standardized protocols, cost-effectiveness of screening
MeSH terms
Echocardiography, Heart Defects, Congenital, Humans

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