Conclusions
The ongoing diagnostic dilemma of CHDs being the most common group of
malformations affecting fetuses and newborns and the varying detection
rates of CHDs in the general population merits consideration as the
prenatal screening for CHDs remains flawed16. The
clinical relevance of this issue is obvious considering that an
estimated 60 % of newborns with CHDs will require a corrective
intervention throughout their lives. Fifty percent of affected newborns
need an intervention in their first year of life, among whom two-thirds
are characterized as being critical regarding short-term morbidity and
mortality (20 % of all CHDs)20. Moreover, CHDs
diagnosed postnatally result in greater costs merely related to
emergency transportation of ill infants103. Despite
the adoption of updated screening guidelines, the implementation of
series of diagnostic planes to visualize cardiac anatomy, 2-dimensional
echocardiography shows limitations related to image acquisition, angle
dependency and, most strikingly, operator experience.
The advantages of 3D/4D echocardiography (STIC) over conventional 2D
ultrasound in delineating cardiac anatomy have been clearly elaborated.
Being less operator-dependent, it allows for more reproducible and
objective echocardiographic assessment of the fetal cardiac morphology
and function of all chambers and valves. However, a number of
publications have argued that the additional value of 3D/4D US in the
prenatal diagnosis of CHDs is rather limited and has only been reported
in centers with high expertise as it requires extra time and effort1,104-106. Since the introduction of a semiautomatic
technology (FINE), a standardized volumetric approach for cardiac
anatomic assessment has become available to overcome the limitations of
effective performance of fetal cardiac examination. FINE has recently
been shown to enable cardiac evaluation in normal and CHD-affected
fetuses with both high specificity and sensitivity6.
We demonstrated the superior value of this approach to comprehensively
assess altered cardiac anatomy. It has previously been shown that the
acquisition plane and insonation angle are crucial for both 2D image
quality and proper volume computing107. It is of note
and illustrated herein that the use of standardized procedures, namely,
automatically realigned cardiac planes facilitate a systematic
evaluation of the fetal heart virtually irrespective of fetal position.
FINE provides the opportunity for even unexperienced operators to become
familiar with the anatomy of the fetal heart and the spatial
relationships of the heart structures. From our perspective, it seems
logical as a next step that 4DUS with subsequent FINE application could
be incorporated in daily practice in the future. However, using such
technology to examine the fetal heart requires an important
prerequisite, i.e., structured training interventions and feedback for
sonologists to acquire high-quality volume data sets so that they are
informative15,108,109.