Application Of Early Pregnancy Ultrasound In Screening For Severe Congenital Heart Disease

Objective To investigate the value of The 11～13+6 Weeks Scanning in the detection of major congenital heart disease(CHD).Methods The 11～13+6 Weeks Scanning was performed on 433 fetuses(crown-rump length between 45 and 84mm)coming to our hospital between July 2014 and June 2016.Ultrasound soft markers,including nuchal translucency,tricuspid regurgitation and flow pattern of ductus venosus were observed.Furthermore,the fetal heart was examined by obtaining the transverse abdominal view,four-chamber view,left ventricular outflow view and three vessels and trachea view.Major CHD was diagnosed according to the echocardiographic characteristics of second trimester fetal echocardiography.Based on the results of follow-up,the value of The 11～13+6 Weeks Scanning in the prediction of major CHD was investigated and the relationship between ultrasound soft markers and major CHD was analysed.To the normal fetus,Factors likely affecting the detection rate of each view were investigated.Results Three hundred and sixty one singleton fetuses were included in this study.Ultrasound soft markers were found in 73 fetuses,including 36 cases of increased nuchal translucency,15 cases of tricuspid regurgitation,10 cases of reversed A wave of ductus venosus and 12 cases of 2 or more markers.Ten cases of major CHD were suspected by The 11～13+6 Weeks Scanning and confirmed by follow-up.Six received autopsy,4 of which were correctly diagnosed and 2 were misdiagnosed.Additional 2 fetuses with major CHD were detected during follow-up.The sensitivity,specificity,positive predictive value and negative predictive value of The 11～13+6 Weeks Scanning in prediction of major CHD were 83.3%(10/12,83.3%),100%(349/349,100%),100%(10/10,100%)and 99.4%(349/351,99.4%),respectively.Increased nuchal translucency,tricuspid regurgitation,combination of increased nuchal translucency and tricuspid regurgitation could effectively indicate major CHD.The detection rates of fetal cardiac views increased with gestational age during the first trimester.The visualization of four-chamber view was influenced by the position of placenta.The visualization of three-vessel and trachea view was influenced by the presence of restrictive fetal position and the distance between transducer and fetal heart.The complete assessment of the fetal heart was influenced by the gestational age and distance between transducer and fetal heart.Conclusion The detection rates of fetal cardiac views increase with gestational age during the first trimester.Most major CHDs can be detected at early stage of pregnancy.Increased nuchal translucency and tricuspid regurgitation can effectively indicate major CHD.The 11～13+6 Weeks Scanning in the prediction of major CHD is feasible and effective,and can be applied widely.