Prenatal screening for congenital heart disease using real-time three-dimensional echocardiography and a novel "sweep volume' acquisition technique

Objectives Conventional prenatal screening for congenital heart disease (CHD) involves a time-consuming and highly operator-dependent acquisition of the four-chamber view and outflow tracts. By acquiring the entire fetal heart instantaneously as a single volume, real-time three-dimensional echocardiography, (RT3DE) may facilitate fetal cardiac screening. Methods Four reviewers, each experienced with fetal cardiac imaging, blindly, and independently evaluated a single cardiac volume from each of 18 fetuses (11 normal, seven with CHD). Two-dimensional echocardiography served as the gold standard. Three-dimensional evaluation of each fetus included a series of volume acquisitions lasting 2-6 s each. A 'sweep volume' technique was developed to fit larger hearts into a single non-gated volume. Results RT3DE had a high sensitivity for detecting CHD (93%), with only a single case being missed by two observers. Specificity, for CHD was low (45%), with a high rate of 'cannot determine' responses and false positive artifacts. Conclusions These preliminary results suggest that RT3DE has the potential to function as a screening tool for fetal heart disease. However, artifacts must be recognized and minimized, resolution must improve, and substantial training will be necessary, prior to widespread clinical use. Copyright (c) 2005 ISUOG. Published by John Wiley & Sons, Ltd.