Fetal heart anomalies detected during the first trimester screening examination – what we cannot assess?

  • Dr Pawel Wlasienko, Perinatology and Perinatal Cardiology Unit, 2nd Department of Obstetrics and Gynaecology, Medical University of Warsaw, Poland
  • Dr Anita Hamela-Olkowska, Perinatology and Perinatal Cardiology Unit, 2nd Department of Obstetrics and Gynaecology, Medical University of Warsaw, Poland
  • Dr Joanna Dangel, Perinatology and Perinatal Cardiology Unit, 2nd Department of Obstetrics and Gynaecology, Medical University of Warsaw, Poland

    • Objective: To assess possibility of fetal heart evaluation between 11,0-13,6 weeks.
    Methods: Prospective echocardiography in 1170 fetuses between 2004-2008, CRL45-84mm, heart anatomy was verified in the second trimester.
    Results: Mean maternal age was 30 years. 237(20%) mothers were >35. In 87(7%)pts NT was >95centile. All 17(1,5%)fetuses with abnormal karyotype, except 1 with trisomy 18, had increased NT. 4-chamber view was visualized in 93% and outflow tract in 80% fetuses.
    In 22 pts CHD was detected in first trimester: Cantrell pentalogy, HLHS, left isomerism with CHB, PS/VSD with trisomy 18, AVSD with trisomy 21. In 2 the picture was unclear and in repeated scan in 16/18 weeks TOF was diagnosed. In 13 pts heart anomaly was not detected in the first trimester scan–they had small VSDs. NT>95 centile was in 17(44%) fetuses with CHD. 19 fetuses with CHD were karyotyped and in 8(20%) it was abnormal: 3-trisomy 21, 4–monosomy X and 1-trisomy 18. There were early rhytm disturbances in 2 cases: (CHB/normal karyotype/left isomerism and tachycardia(FHR-187)/monosomy X/normal heart anatomy) – both fetuses died in utero.
    Conclusions: Fetal heart can be assessed in a reference perinatal cardiology center since 11th week. In fetuses with CHD there is a high risk of abnormal karyotype. HLHS can be detected since the first trimester screening examination. Conotruncal anomalies may present dubious scan in first trimester, leading to early re-scan in early second trimester. Due to difficulties in visualization of VS a control echocardiographic examination must be performed in each case in the second trimester.