L’échocardiographie au 1er trimestre? E.Quarello Marseille 2011

L’échocardiographie au
1er trimestre?
E.Quarello
Marseille 2011
lundi 25 avril 2011
Pour qui ?
- Famille à risque élevée de Cardiopathie Congénitale
(risque: 2-3%)
- Hyperclarté de nuque
- Malformation(s)
- Fuite tricuspide
- Onde A (-) au niveau du canal d’Arantius
lundi 25 avril 2011
Downloaded from heart.bmj.com on 22 November 2007
hocardiographic correlates of normal cardiac morphology in the late first trimester fetus
Heart 1997;77:68-72
fetus
Figure
image
correlates
Anatomical and echocardiographic
of
"
j
.........
fetus
gestational (54 days post-conception). The
plane from
longitudinal
imaged
head first
The
in(UVT)the
late
normal cardiac morphology
prominent, passing from
front of spine
passing
trimester fetus
connecting
artery (UA)
The
(H)
large
...........
Lindsey D Allan, Rosalba Santos, Tomas
Heart 1997;77:68-72
was obtained in a
with a
1 This
crown-rump length equivalent to 9 weeks 5 days
is
age
to rump.
in a
umbilical vein
is
the cord
through the liver to below the heart. The descending aorta
is seen
down the back in
the
and
in the cord. A
to the umbilical
heart
is seen in the
head vessel is seen.
thorax just above the diaphragm. The ultrasound beam is
then positioned at right angles to this plane of section to
cut through the heart in a transverse plane. The beam is
Pexieder
then swept up and down the thorax to produce the type of
images seen in fig 2.
liver and the equality of the right and left venAbstract
nd
Objectives-To describe the normal car- tricular dimensions when imaged in a four
diac morphology as seen by transvaginal chamber projection. In addition, as was
l
ultrasound imaging in the first trimester expected from our knowledge of fetal physiolfetus and to compare it with the morphol- ogy, the patent foramen ovale and the patent
arterial ductal connection were visible in every
ogy of the heart as seen by microdissection
rse
thorax. at the same gestational age.
normal fetus.
with a Design-In 53 mothers undergoing early
Since 1980 improvements in the resolution
h
the
fetal
heart
was
examined
of
sonography,
vaginal transducers have led to the study of
eks 2
,ge
(Si and the images recorded. The gestational the conceptus at increasingly early stages of geson).
lat the age range was 5-12 weeks of gestation, tation. The evaluation of embryological feaat the which represents 21 to 70 days after contures such as the appearance of the yolk sac and
is stage
the physiological hemiation of the midgut can
cm and ception. Images were analysed frame by
ery less frame and compared with the anatomy of be studied and even used to date the pregnancy
et
etre.
apposi.te
embryos and fetuses at the same gesta- accurately.2 Many of the standard echocardioapex tional ages.
graphic views can be obtained as early as 11 to
and
The
Results-After
the
9th
week
of
12 weeks of gestation' and the atrioventricular
gestation,
ed
four
cardiac
the
aortic
and
arterial Doppler flow velocity profiles can
chambers,
origin,
t half of
colour
and
the
could
be
identibe
pulmonary
artery
analysed.4
this
ndt of
fied onand
crossleft
sectional
The heart is one of the first organs to develop
sthe
were right
ven- echocardiography
ndicates in conjunction with colour flow Doppler.
in
the embryo, with cardiac motion seen
Yr septum
en
a four
his is aimaged
At 9 weeks,in
the apex
pointed anteriorly and between 26 and 32 days after conception' (5-6
the
the right ventricle
and pulmonary artery weeks post-menstrual age), when the crownnofethewalls
as was
fouraddition,
to the right of the midline. By the 11th rump length is between 5 and 10 mm. The
lay
trunk
ofoffetal
ledge
physiolthe apex pointed to the __
atrioventricular endocardial cushions and atrigestation,
fined week
left
and
the
pulmonary
artery
lay
to
the
left
oventricular valves develop in post-menstrual
ovale
and
the
patent
of
the
midline
as
in
the
older
fetus.
weeks
6-7, the outflow tract septum is comIt arose
riclewere
visible
in
ndline
every
Between
9
and
12
weeks'
gestation
the
pleted
between
post-menstrual weeks 7-8, and
to
aorta
was
than
the
larger
pulmonary
the
interventricular
ending
foramen closes between
lour
ed the artery. These findings were confirmed in post-menstrual weeks 8 and 9.6 The tricuspid
inmicrodissected
the resolution
ents
ary
the
hearts.
valve is the last cardiac structure to complete its
e)
Conclusions-The
current
of
ultraat post-menstrual weeks 9-10. We
quality
e. (E) led
ave
to
the
ofusing transvaginal formation
tion just sound imagesstudy
obtained
to evaluate the fetal heart during the
attempted
mber
ngly
stages
in of
transducers
thegesfirst trimester fetus first trimester of pregnancy to see if any part of
w the early
onary allows the study of fetal cardiac anatomy. cardiac development was currently identifiable
of
Cand embryological feaorta
Some of the later developmental changes by the most modem high resolution transducby
of
sac and As technology ers.
nce
canthe
be yolk
demonstrated.
ng
t
improves further the details of earlier carion
red) of the midgut can
mards diac morphogenesis may also become visit this
to date the pregnancy
Patients and methods
iderably ble.
ECHOCARDIOGRAPHIC IMAGES
ow standard echocardioIn 53 patients the fetal heart was imaged using
seen in (Heart 1997;77:68-72)
ained
as early as 11 to
The
an Advanced Technical Laboratories HDI sysn front
tem with a 5 or a 9 MHz vaginal tranducer.
mnd
the the atrioventricular
Keywords: fetus; organogenesis; echocardiography; pre- These patients were referred for ultrasound
a
RV,
natal
diagnosis
w
examination to confirm the presence of an
, left velocity profiles can
a; PA,
intrauterine
pregnancy or to establish viability
Aao,
Advances in prenatal ultrasound imaging, espe- after an episode of vaginal bleeding. The
firstcially
to develop
organs
the advent
of cross sectional scanning, crown-rump length was used to estimate the
allowed
the
echocardiographic
features of the gestational age, which ranged from 5 to 12
cardiac motion
seen
es lundinormal
mid-trimester
fetus
to
be correlated weeks. The gestational ages studied are shown
25 avril 2011
elates of
irst
Published online 10 February 2011 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.8934
69
Fetal echocardiography at 11–13 weeks by transabdominal
high-frequency ultrasound
N. PERSICO*†, J. MORATALLA*, C. M. LOMBARDI‡, V. ZIDERE*, L. ALLAN*
and K. H. NICOLAIDES*§
*Department of Fetal Medicine, King’s College Hospital, London, UK; †Department of Obstetrics and Gynecology ‘L. Mangiagalli’,
Ospedale Maggiore
Policlinico,
Milan, Italy;
‡Studio37:
Diagnostico
Eco, Vimercate, Italy; §Department of Fetal Medicine, University College
Ultrasound
Obstet
Gynecol
2011;
296–301
Hospital, London, UK
Published online 10 February 2011 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.10
K E Y W O R D S: cardiac defects; Doppler ultrasound; linear transducer; nuchal translucency
Fetal echocardiography at 11–13 weeks b
high-frequency ultrasound
ABSTRACT
in pregnancy fails to identify the majority of fetuses
with major cardiac defects2,3 . By contrast, the majority
of such defects are amenable to prenatal diagnosis
Objectives To assess the accuracy of fetal echocarby specialist fetal echocardiography4,5 . Consequently,
diography at 11–13 weeks performed by well-trained
effective population-based prenatal diagnosis necessitates
obstetricians using a high-frequency linear ultrasound
improved methods of identifying the high-risk group
transducer.
for referral to specialists and/or improved standards of
scanning in those undertaking routine screening.
Methods Fetal echocardiography was performed by
Traditionally, high-risk groups have been identified for
obstetricians immediately before chorionic villus sampling
for fetal karyotyping at 11–13 weeks. Digital videoclips
referral for specialist fetal echocardiography, for example,
*Department
of Fetal Medicine, King’s College Hospital, London, UK; †Department of Obstetri
of the examination stored by the obstetrician were
those with a family history of cardiac defects, maternal
Ospedale
Maggiore
Policlinico,
Milan, Italy; ‡Studio
Eco, Vimercate,
§Depart
reviewed offline
by a specialist
fetal cardiologist.
historyDiagnostico
of diabetes mellitus
and maternalItaly;
exposure
to
Hospital, London, UK
teratogens. However, the performance of this method
Results The obstetrician suspected 95 (95%) of the 100
of screening is poor, with a detection rate of only
cardiac defects identified by the fetal cardiologist and
approximately 10% of cases of fetal cardiac defects6 .
K
E Ythe
Wcorrect
O R Ddiagnosis
S: cardiac
defects;
Doppler
made
in 84 (84%)
of these
cases. ultrasound; linear transducer; nuchal transluce
A major improvement in screening for cardiac defects
In 54 fetuses, the defect was classified as major and in
came with the widespread introduction of four-chamber
46 it was minor. In 767 (86.6%) cases, the heart was
view screening during the routine mid-trimester scan7 .
normal and in 19 (2.1%) the views were inadequate
First-trimester screening for aneuploidies by measurement
for assessment of normality or abnormality. A subsequent
of fetal nuchal translucency (NT) thickness identified
second-trimester scan in the normal group identified major
another important high-risk group8 . A meta-analysis
cardiac defects in four cases. Therefore, the first-trimester
performance offails
NT
scan
A
B by
S TtheRobstetricians
A C T and cardiologists identified 54 of studies examining the screening
in pregnancy
thickness
for
the
detection
of
cardiac
defects
in
euploid
(93.1%) of the 58 major cardiac defects.
with
major
cardiac
fetuses reported that the detection
rate was
23% for
an NT
Conclusions A well-trained obstetrician using highcut-off of the 99th centile9 . There
is
also
evidence
that
of such defectsthe ar
resolution ultrasound equipment can assess the fetal heart
detection rate may be improved further by the additional
Objectives
Toa high
assess
the
accuracy
fetal
echocarat 11–13 weeks with
degree of
accuracy.
Copyright of early
by specialist
sonographic markers of aneuploidy,
abnormalfetal
flow
 2011 ISUOG. at
Published
by John
Wiley &performed
Sons, Ltd.
diography
11–13
weeks
by well-trained
through
the ductus venosus10effective
and across populationthe tricuspid
valve11 .ultrasound
In the presence of abnormal flow, the risk for
obstetricians using a high-frequency linear
improved
cardiac
defects
in euploid fetuses
is increased. methods
INTRODUCTION
transducer.
In the last 10 years, as a consequence of inclusion of
for referral to speci
‘aneuploidy sonographic markers’ in screening for cardiac
Abnormalities of the heart and great arteries are
in those
Methods
Fetalcongenital
echocardiography
was defects,
performed
bya shift scanning
there has been
in specialist fetal
echocar-un
the most common
defects and account for
diography
from
the
second
to
the
first
trimester
of pregapproximately 20%
of all stillbirths
and 30%
of
Traditionally,
high
obstetricians
immediately
before
chorionic
villus
12,13sampling
1
nancy
.
A
technical
limitation
in
such
early
echocarneonatal deaths due to congenital defects . Several
for
fetal
karyotyping
at ultrasound
11–13 weeks.
videoclips
referral
for specialist
diography
is visualization of the
desired structures.
studies
have established
that routine
screening Digital
N. PERSICO*†, J. MORATALLA*, C. M. LOMBARDI‡, V. ZIDERE*,
and K. H. NICOLAIDES*§
of the examination stored by the obstetrician were
reviewed offline by a specialist fetal cardiologist.
those with a family
history of diabetes
Correspondence to: Prof. K. H. Nicolaides, Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital Medical School,
teratogens. Howeve
Denmark Hill, London SE5 8RX, UK (e-mail: [email protected]almedicine.com)
Results
The
obstetrician
suspected
95
(95%)
of
the
100
Accepted: 23 December 2010
of screening is poo
cardiac defects identified by the fetal cardiologist and
approximately 10%
made
the correct diagnosis in 84 (84%) of these cases.
ORIGINAL PAPER
Copyright  2011 ISUOG. Published by John Wiley & Sons, Ltd.
A major
improveme
In 54 fetuses, the defect was classified as major and in
came with the wides
46 it was minor. In 767 (86.6%) cases, the heart was
How successful is fetal echocardiographic examination in
the first trimester of pregnancy?
Blackwell Science, Ltd
Figure 3 Ultrasound image of the pulmonary trunk originating from the
2
W. R. TWISK†
and the
J. M. three-vessel
G. VAN VUGT* view in a fetus at 13+4 weeks’
right J.ventricle,
with
A,M. C. HAAK*,
*Department of Obstetrics and Gynecology, ‘Vrije Universiteit’ Medical Center, Amsterdam and †Department of Clinical Epidemiology and
gestation; crown–rump length, 75 mm. Ao, aorta; SVC, superior vena
Biostatistics, ‘Vrije Universiteit’ Medical Center, Amsterdam, the Netherlands
Ultrasound Obstet Gynecol 2002; 20: 9 – 13
cava; PA, pulmonary artery; Sp, spine.
K E Y W O R D S: Cardiac examination, Echocardiography, First trimester, Normal pregnancies, Transvaginal ultrasound
How
successful
is
fetal
echocardiographic
examination
Table 4 Success rate for full cardiac examination
the first trimester of pregnancy?
Blackwell Science, Ltd
ABSTRACT
INTRODUCTION
Gestational age (weeks)
Success rate (%)*
M. C. HAAK*, J. W. R. TWISK† and J. M. G. VAN VUGT*
11+0 to 11+6
20
12+0 to 12+6
60
13+0 to 13+6
92
Objective Transvaginal echocardiography is still rarely
First-trimester transvaginal ultrasound examination has been
incorporated into the first-trimester ultrasound examination,
an established method to detect many structural abnordespite the fact that heart defects are the most frequently
malities for several years1,2. Despite a few reports on the possibilities of visualizing
and examining
the fetal
heart
at this
encountered congenital
malformation.
This study
was Universiteit’
*Department
of Obstetrics
and Gynecology,
‘Vrije
Medical 3–5
Center,
Amsterdam
and
†Department
of Clinical Epid
early gestational age , transvaginal echocardiography in
undertaken to explore the possibilities of fetal echocardioBiostatistics,
‘Vrije Universiteit’ Medical Center, Amsterdam,
the Netherlands
the late first trimester remains a rarely applied method. This
graphy in the late first trimester.
despite the fact that heart defects are the most frequently
Methods In 85 women with uncomplicated singleton
encountered congenital malformation, affecting 4 –8 infants
pregnancies, three transvaginal ultrasound examinations
per 1000 births6.
between
13+6
weeks’ gestation
were performed.
K
E Y W11+0
O Rand
D S:
Cardiac
examination,
Echocardiography,
First
trimester,
Normal
pregnancies,
This study was
undertaken
to explore
the relevance
of fetal Transvaginal ultr
The examinations were carried out at weekly intervals
echocardiography in the late first trimester of pregnancy and
and visualization of several echocardiographic planes was
to construct growth curves of the aortic root and pulmonary
attempted (four-chamber view, aortic root, long axis of
trunk for this gestational age. The study also aimed to deterthe aorta, pulmonary trunk with three-vessel view, crossmine the optimal gestational age at which to perform transover of the great arteries). The diameter of the aorta and
vaginal echocardiography.
pulmonary trunk were measured to establish reference
ranges.
*Rounded.
earlier in gestation than the aortic root (75.3% vs. 32.9% at
11+0
ABSTR
A C T to 11+6 weeks of gestation).
I N T R O D U disappears
CTION
M E T H O D SThis difference
Results The success rate of visualization of the different
women
singleton
pregnancies
participated vs.
gradually
with
the
increasing
ofwiththe
fetus
(97.6%
parameters
increased
with gestational
age.
The ability
to isEighty-nine
Objective
Transvaginal
echocardiography
stillsize
rarely
First-trimester
transvaginal
ultrasound exam
perform
a full
lundi
25 avril 2011
cardiac examination increased from 20%
in the study. They received written information and gave
incorporated into the first-trimester ultrasound examination,
an established method to detect many st
Not on ultrasound n = 1 (Case 183)
n = 29 (Cases 67,
Cardiac malformations
in first-trimester
fetuses with increased n = 30
Total
n=8
Blackwell Science, Ltd
nuchal translucency: ultrasound diagnosis and postmortem
*Ignoring minor defects and unsuccessful examinations. A&H, alive and healthy.
morphology
M. C. HAAK*, M. M. BARTELINGS†, A. C. GITTENBERGER-DE GROOT† and J. M. G. VAN VUGT*
*Department of Obstetrics and Gynecology, ‘Vrije Universiteit’ Medical Center, Amsterdam and †Department of Anatomy and Embryology, Leiden
improved
in 40 singleton first-trimester pregnancies with nuchal translucency
porated m
thickness
> Echocardiography,
95th centile First
at two
levels
oftranslucency,
agreement
KEYWORDS: Cardiac
examination,
trimester,
Nuchal
Postmortem, Transvaginal
of the he
ultrasound
Cardiac malformations in first-trimester fetuses with
inc
cificity (8
Detailed agreement
General agreement
nuchal translucency: ultrasound
diagnosis
and postmor
is of an
(n (%))
(n (%))
echocard
Conclusion Transvaginal echocardiography can be permorphology
ABSTRACT
formed
Sensitivity
7/13reliably
(54) in first-trimester fetuses
7/8 with
(88)an increased
discrepan
Objective The aim of this study was to explore the diagnosNT. In this study, the proportion of chromosomally
Specificity
26/27
29/30
(97)
tic accuracy of first-trimester
transvaginal echocardiography
abnormal(96)
fetuses with a heart defect
was not
different from
nosis
on
p
in
fetuses
with
increased
nuchal
translucency
(NT)
thickness,
that
found
in
newborns,
except
for
cases
of
Turner
synM. C. HAAK*,
M. M. BARTELINGS†,
A.
GITTENBERGER-DE
False-positive
rate
1/8C.(13)
1/8 (13)GROOT† and J. M. G. V
by comparing the ultrasound diagnosis with the findings on
drome. Fetal demise occurred in all three euploid fetuses with
on
postm
*Department
of
Obstetrics
and
Gynecology,
‘Vrije
Universiteit’
Medical
Center,
Amsterdam
and
†Department
of
Anatomy
and Emb
False-negative
rate
(19)
1/30
(3)defect had a
postmortem examination
or mid-gestational
ultrasound and
a 6/32
heart malformation.
The fetuses with
a heart
University
Medical
Center, Leiden,
The Netherlands
primum A
neonatal outcome.
larger
than did those without. 7/8 (88)
Positive
predictive
value
7/8 NT
(88)
Methods Transvaginal
echocardiography
was performed
defects ar
Negative
predictive
valuein 26/32 (81)
29/30 (97)
45 fetuses with a NT > 95th centile. Karyotyping was
performed in 43. In 20 of the 23 pregnancies in which
INTRODUCTION
third-trim
K
E
Y
W
O
R
D
S:
Cardiac
examination,
Echocardiography,
First
trimester,
Nuchal
translucency,
Postmortem,
Trans
termination of pregnancy was carried out, postmortem
Measurement of the fetal nuchal translucency (NT) thickness
tem is fur
examination was performed to determine the presence and
ultrasound
in the late first trimester of pregnancy has become an estabtype of heart defect. Mid-gestational echocardiography was
lished method for identifying fetuses at risk for aneuploidy .
The en
performed in ongoing pregnancies and neonatal follow-up
The frequent occurrence of heart malformations in fetuses
information was obtained. Findings on first-trimester transultrasound,
the
sensitivity
to 88%
with
a false-negative
study did
or in combination
withrose
an enlarged
NT, either
isolated
vaginal
echocardiography
were
compared
to
those
of
second45 embryons CN ≥95e p
with a chromosomal abnormality , has gained much
trimester
echocardiography
or
the
results
of
postmortem
value
of
3%
(Table
7).
the cases
10 malformations cardiaques
attention. It was suggested that NT thickness measureexamination. The mean NT in the fetuses with and without
ment could also be used as a screening tool for fetal heart
Conclusion
To
compare
the
mean
NT in fetuses
with orTransvaginal
without aechocardiography
common
heart
defects
was
calculated.
lundi 25 avril 2011
malformations in an unselected population . FurtherUltrasound
Obstet
Gynecol
20: 14 – 21 characteristics of transvaginal echocardiography
Table
7 2002;
Performance
University Medical
Center,
Leiden, The
Netherlands
Blackwell Science, Ltd
1–3
4–6
7,8
9
A systematic review of the accuracy of first-trimester
ultrasound examination for detecting major congenital
heart disease
S. V. RASIAH*, M. PUBLICOVER†, A. K. EWER*, K. S. KHAN‡, M. D. KILBY‡ and J. ZAMORA§
*Department
112of Neonatology, †Library Services and ‡Department of Maternal and Fetal Medicine, Birmingham Women’s Hospital,
Ultrasound
Obstet
2006;
28:of 110–116
Division of Reproduction
andGynecol
Child Health,
University
Birmingham, Edgbaston, Birmingham, UK and §Clinical Biostatistics Unit,
Hospital
Romony
Cajal, Madrid,
SpainInterScience (www.interscience.wiley.com). DOI: 10.1002/uog.2803
Published
online
in Wiley
Rasiah et al.
Table 1 Study characteristics of the articles included in the systematic review of the accuracy of first-trimester fetal echocardiography
K E Y W O R D S: congenital heart disease;
Year offirst trimester; systematic review; ultrasound scan
publication
Authors
(study period)
Country
Study population
Gestational
range scans
done (weeks)
Number
of fetuses
< 14 weeks
A systematic review of the accuracy of first-trimest
ultrasound examination for detecting major conge
heart disease
Carvalho et al.27
Huggon et al.29
A B S T RGalindo
A C T et al.34
2004 (1997–2002)
2003 (2000–2001)
2003 (1997–2003)
Ultrasound
approach
England
England
Spain
High-risk; increased NT
10–16
79
Transabdominal
High-risk; increased NT
11–14
262
Transabdominal
increased
NT postnatally
12–161,2 . In addition,
41
Transvaginal &
orHigh-risk;
palliative
surgery
the
presence of CHD increases perinatal mortality. Prenataltransabdominal
30
Objective
To
evaluate
the
accuracy
of
first-trimester
Weiner et al.
2002 (1995–1999)
Israel
High-risk
11–14
392
Transvaginal
ultrasonography
with fetal echocardiography
performed
28
ultrasound
examination
in2002
detecting major congenital
Netherlands
High-risk; increased NT
11–14
38
Transvaginal
Haak
et al.
at
18–20
weeks’
gestation
is
used
routinely
to
screen
33
Comas(CHD)
et al.
(1999–2001)
Spain
High-risk
12–17
117
Transvaginal &
heart disease
using2002
a systematic
review
of the
for CHD. The ultrasound examination is based ontransabdominal
literature.
examination
of a ‘four-chamber
view’ of the 17
heart, with
1999 (1997–1998)
England
High-risk; increased
NT
13–16
Transabdominal
Zosmer et al.31
17
MethodsCarvalho
Generaletbibliographic
and
specialist
computeradditional
examination
great
and aortic
al.
1998 (1995–1997)
England
High-risk; increased
NT of12the
to 13
+ 6 vessels 11
Transabdominal
32
ized databases
searching of reference
1994 (1991–1993)
Israel
Unselected
201such scans
Transvaginal
Achironalong
et al. with manual
arch.
The screening specificity13–15
and sensitivity of
14
*Department
of
Neonatology,
†Library
Services
and
‡Department
of
Maternal
and
Fetal
Medicine,
Gembruch
et al.
(1988–1992)
Germany
Unselected
11–16
85
TransvaginalBirmingham
lists of primary
and
review1993
articles
were used to
search
are
variable, with some studies
indicating a detection
rate
S. V. RASIAH*, M. PUBLICOVER†, A. K. EWER*, K. S. KHAN‡, M. D. KILBY‡ an
W
Division
Reproduction
andincluded
Child Health,
Birmingham,
Edgbaston,
UK and §Clinica
for
relevantofcitations.
Studies were
if a first-University
as low asof
26%
in an unselected
population3Birmingham,
. However,
All
studies were
carried
in tertiary
referral
nuchalechocardiography
translucency.
trimester
ultrasound
scan
wasout
carried
out to
detectcenters.
CHD NT, fetal
in experienced hands performed
Hospital
Romony
Cajal,
Madrid,
Spain
that was subsequently verified by a reference standard.
in the second and third trimesters has a sensitivity of
Data were extracted on study characteristics and quality,
60–100% for
diagnosing
major CHD
even in a low-risk
(95%
CI, 98–100%),
respectively.
The findings among
Potentially relevant citations
4–9
17,27,28,30,34
and 2 × 2identified
tables were
constructed
to
calculate
sensitivity
screening population
by initial screening
had a pooled sensitivity
high-quality. studies
globale
and specificity.
(from all sources searched)
With improved
has become
to of 99% (95%
of 70%technology
(95% CI, it55–83%)
and feasible
specificity
n
=
622
K E Y W O R D S: congenital heart disease; first
trimester;
systematic
review;
ultrasound
scan
obtain
images
the fetal heart
in predominantly
the first
trimester,
CI, of
98–100%).
Studies
undertaken before
Results Ten studies (involving 1243 patients) were
globale
with visualization
both
the –four
heart
chambers
14,17,30
32
had
a lower
sensitivity of 56%
the yearof2000
suitable for inclusion. Of these,
fourexcluded
used transabdominal
Citations
as
and the outflow tracts of the great vessels being
ultrasonography, four used transvaginal
(95% CI, 35–75%) compared with
those carried out after
not relevant and two used
10,11
performed
from
as
early
as
11
weeks’
gestation
. The
27
–
29,33,34
n = 539
a combination. Pooled sensitivity
and specificity were
2000
, which had a sensitivity of 92% (95% CI,
majority of the initial studies were carried out using
lundi 25 avril 2011
Sensibilité
Spécificité
: 85% (IC 95%, 78-90%)
: 99% (IC 95%, 98-100%)
Que peut-on doit on voir ?
Situs
Connections atrio-ventriculaires
Connections ventriculo-artérielles
Identification des cavités cardiaques et leur symétrie
Croisement des gros vaisseaux
Evaluation du flux: valves, cavités et gros vaisseaux
lundi 25 avril 2011
Echocardiographie
au
1er trimestre
lundi 25 avril 2011