Improvement of the Diagnostics of the Fetus Heart Anomalies During a Routine Screening Ultrasound Examination

Abstract

Introduction. Anomalies of the heart and major vessels of the fetus take the first place in the structure of mortality from the abnormalities developed in the early neonatal period, they occur with a frequency of 7 to 17 per 1000 newborns and cause about 40.0% of perinatal losses. Given the fact that preventative measures for the prevention of congenital heart diseases are not successful, their prenatal ultrasound diagnosis is relevant. There are cardiological abnormalities that are incompatible with life – in these cases, it is proposed to interrupt pregnancy. There are heart defects that can serve as markers for chromosomal abnormalities. Some variants of the congenital heart diseases can be adjusted by surgical intervention immediately after birth (such patients must be born in specialized centers). In addition, modern medicine is at such a stage of development that some structural anomalies of the heart can be eliminated even during the intrauterine period of the life of the fetus with the best pathway. Aim. To improve the diagnosis of fetal heart abnormalities during the routine screening ultrasound. Materials and methods. Recommendations for the improvement of the diagnosis of fetal heart anomalies by the routine screening ultrasound examination in the second trimester of pregnancy by the additional visualization of the major vessels with an assessment of the average diameter, the location of the heart axis, the ratio of the chambers of the heart and the size of the pulmonary artery, aorta and upper vena cava. Results. It is believed that the results of prenatal research is mainly influenced by the technical reasons (resolution of the device, pregnancy period, thickness of the anterior abdominal wall of the mother, position and size of the fetus). In our opinion, the prenatal detection of congenital heart defects strongly depends on the algorithm of conducting a fetal heart study in the screening regimen. All screening ultrasounds should be performed according to a single protocol, which is the main for the standardization of echographic research. In the case of suspicion of airborne disease in the fetus, the patient is referred for medico-genetic counseling with karyotyping and verifying the diagnosis. The main screening examination of the heart is based on a four-chamber cut. To obtain this image, the sensor should be installed perpendicularly to the fetal ridge at the level of atrioventricular valves. During the adequate withdrawal of this section, the right and left ventricles, right and left atrium, interventricular and interatrial septum, mitral valve and tricuspid valve openings are clearly visualized (the level of the tricuspid valve is normally slightly lower than mitral), an oval window can also be seen. Conclusions. During the additional visualization of the major vessels more than 90.0% of congenital heart defects can be diagnosed, indicating the need to optimize the protocol for the providing of the assistance of such patients, and the basic specific criteria for evaluating the anatomy of the heart and the fetal heart. So, the study of fetal heart is one of the most important stages of screening ultrasound in the second trimester of pregnancy.

Keywords

• fetus heart anomalies
• ultrasound examination