Luciane Alves Rocha

Reference ranges of atrioventricular valve areas by means of four-dimensional ultrasonography using spatiotemporal image correlation in the rendering mode.

This study aims to determine reference curves for fetal atrioventricular valve areas by means of three‐dimensional ultrasound using the spatiotemporal image correlation (STIC) software.

Reference Range for Fetal Interventricular Septum Area by Means of Four-Dimensional Ultrasonography Using Spatiotemporal Image Correlation

Objective: To determine reference range for fetal interventricular septum area by means of 3-dimensional ultrasonography (3DUS) using the spatiotemporal image correlation (STIC) method. Methods: A prospective, cross-sectional study was conducted on 328 normal pregnant women between the 18th and 33rd gestational weeks. To obtain the interventricular septum area, a virtual plane was used, with the green line (region of interest) adjacent to the external margin of the septum, which was manually delimited. To evaluate the correlation of the septum area with the gestational age, different regression modes were evaluated. The intraclass correlation coefficient was used to evaluate the interobserver reproducibility. Results: The interventricular septum area showed correlation with the gestational age (r = 0.81). The mean increased from 0.47 ± 0.10 cm2 in the 18th week to 2.42 ± 1.13 cm2 in the 33rd week of gestation. The mathematical equation that best represented this correlation was provided by linear regression: interventricular septum area = 0.0511 × gestational age (R2 = 0.095). The interobserver reproducibility was good, with bias of 0.01 cm2, precision of 0.07 cm2 and absolute limits of agreement of -0.14 and +0.15 cm2. Conclusions: Reference range for fetal interventricular septum area were determined by means of 3DUS using STIC in the rendering mode and were shown to be reproducible.

The value of 3D and 4D assessments of the fetal heart.

The objective of this review was to demonstrate the main tools of three- and four-dimensional ultrasonography, using the spatiotemporal image correlation software and its respective applications for assessing the fetal heart and its vascular connections, along with its potential contribution towards screening for congenital heart diseases. Today, conventional, two-dimensional, echocardiography continues to be the gold standard for diagnosing congenital heart diseases. However, recent studies have demonstrated that spatiotemporal image correlation offers some advantages that boost two-dimensional accuracy in detecting congenital heart diseases, given that the fetal heart assessment can be completed in the absence of the patient (offline) and be discussed by different examiners. Additionally, data volumes can be sent for analysis in reference centers via internet links. Spatiotemporal image correlation also enables direct measurement of heart structures in rendering mode, such as the interventricular septum and the annulus of the atrioventricular valves. Furthermore, it enables assessment of cardiac function when used in association with the virtual organ computer-aided analysis software, thus making it possible to calculate the total systolic function, ejection fraction, and cardiac output.

Fetal cardiac output and ejection fraction by spatio-temporal image correlation (STIC): comparison between male and female fetuses

OBJECTIVE To compare the cardiac output (CO) and ejection fraction (EF) of the heart of male and female fetuses obtained by 3D-ultrasonography using spatio-temporal image correlation (STIC). METHODS We conducted a cross-sectional study with 216 normal fetuses, between 20 and 34 weeks of gestation, 108 male and 108 female. Ventricular volumes at the end of systole and diastole were obtained by STIC, and the volumetric assessments performed by the virtual organ computer-aided analysis (VOCAL) rotated 30º. To calculate the DC used the formula: DC = stroke volume / fetal heart rate, while for the FE used the formula: EF = stroke volume / end-diastolic volume. The DC (combined male and female) and EF (male and female) were compared using the unpaired t test and ANCOVA. Scatter plots were created with the percentiles 5, 50 and 95. RESULTS The average of DC combined, DC left, DC right, FE right and FE left, male and female were 240.07 mL/min, 122.67 mL/min, 123.40 mL/min, 72.84%, 67.22%, 270.56 mL/ min, 139.22 mL/min, 131.34 mL/min, 70.73% and 64.76% respectively, without statistical difference (P> 0.05). CONCLUSIONS The fetal CO and EF obtained by 3Dultrasonography (STIC) showed no significant difference in relation to gender.OBJECTIVE: To compare the cardiac output (CO) and ejection fraction (EF) of the heart of male and female fetuses obtained by 3D-ultrasonography using spatio-temporal image correlation (STIC). METHODS: We conducted a cross-sectional study with 216 normal fetuses, between 20 and 34 weeks of gestation, 108 male and 108 female. Ventricular volumes at the end of systole and diastole were obtained by STIC, and the volumetric assessments performed by the virtual organ computer-aided analysis (VOCAL) rotated 30o. To calculate the DC used the formula: DC = stroke volume / fetal heart rate, while for the FE used the formula: EF = stroke volume / end-diastolic volume. The DC (combined male and female) and EF (male and female) were compared using the unpaired t test and ANCOVA. Scatter plots were created with the percentiles 5, 50 and 95. RESULTS: The average of DC combined, DC left, DC right, FE right and FE left, male and female were 240.07 mL/min, 122.67 mL/min, 123.40 mL/min, 72.84%, 67.22%, 270.56 mL/ min, 139.22 mL/min, 131.34 mL/min, 70.73% and 64.76% respectively, without statistical difference (P> 0.05). CONCLUSIONS: The fetal CO and EF obtained by 3Dultrasonography (STIC) showed no significant difference in relation to gender.

Reference ranges for the volumes of fetal cardiac ventricular walls by three‐dimensional ultrasound using spatiotemporal image correlation and virtual organ computer‐aided analysis and its validation in fetuses with congenital heart diseases

To establish reference values for the volumes of fetal cardiac ventricular walls using three‐dimensional ultrasonography (3DUS) and perform data validation using fetuses with confirmed congenital heart disease (CHD).

Assessment of Quality of Fetal Heart Views by 3D/4D Ultrasonography Using Spatio-Temporal Image Correlation in the Second and Third Trimesters of Pregnancy

To assess the quality of fetal heart views by three‐dimensional/four‐dimensional (3D/4D) ultrasonography using spatio‐temporal image correlation (STIC) in the second and third trimester of pregnancy.

Fetal Myocardial Wall Area: Constructing a Reference Range by Means of Spatiotemporal Image Correlation in the Rendering Mode

Objective: To establish the reference range of the myocardial wall area in the fetus using three-dimensional ultrasound in the rendering mode. Methods: A prospective, cross-sectional study including 371 singleton, uncomplicated pregnancies at 20 weeks 0 day to 33 weeks 6 days of gestation was carried out. Cardiac volumes were obtained using spatiotemporal image correlation (STIC) at the level of the four-chamber view. The end-diastolic myocardial area of the both ventricles was measured manually. The intraclass correlation coefficient (ICC) was used to assess intra- and interobserver concordance. Results: The mean myocardial area of the fetal right ventricular (RV) wall ranged from 0.86 ± 0.23 cm2 at 20 weeks 0 day to 2.75 ± 0.69 cm2 at 33 weeks 6 days of gestation. The mean myocardial area of the fetal left ventricular (LV) wall ranged from 0.82 ± 0.20 cm2 at 20 weeks 0 day to 2.49 ± 0.59 cm2 at 33 weeks 6 days of gestation. In addition, intra- and interobserver concordance for the myocardial area of the RV and LV walls was good, with ICC values of 0.94, 0.95, 0.85, and 0.93, respectively. Conclusions: The reference range for the myocardial area of the RV and LV walls was determined by cardio-STIC in the rendering mode at 20 weeks 0 day to 33 weeks 6 days of gestation, with good concordance between values.

Screening of fetal congenital heart disease: the challenge continues

Congenital heart disease (CHD) is the most common congenital malformation [1] in fetuses. It affects eight per 1,000 live births and is more common antenatally [2-5]. In beginning, cardiac evaluation was confined to pregnancies at increased risk of CHD, such as those with a family history of CHD or where extracardiac malformations had been detected. However, up to 86% of CHD occurs in pregnancies where there are no known high risk features [6], emphasizing the need for an effective fetal cardiac screening program for all pregnancies [7,8]. For this reason, in the mid 80’s started the idea of teaching the obstetrician to assess the heart in a simplified form during routine obstetric scanning [9,10]. Four chamber view scanning became an integral part of the fetal anatomical survey in many countries by the end of the 1980s [9,10]. However, prenatal screening based on visualization of the four-chamber view has much lower sensitivity [6,11]. This is partly because the four-chamber view may appear normal in cases of many anomalies, such as transposition of the great vessels, tetralogy of Fallot, double outlet right ventricle, truncus arteriosus, pulmonary or aortic stenosis/atresia and coarctation of the aorta. Anomalies of the great vessels are associated with an abnormal four-chamber view in 30% of cases [12]. When four-chamber and great vessels view are examined, the sensitivity of ultrasound screening for congenital heart defects increases from approximately 30% to 69–83% [6,11,13]. Therefore, we support the idea of evaluation both the four-chamber view and the outflow tracts (Figure 1). Then, we could improve the rate of prenatal detection of congenital heart disease. In 2006, the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) published a guideline in which they described the “basic” and “extended basic” cardiac ultrasound examinations [14]. The intention was to standardize the assessment and to maximize the detection of heart anomalies during the second-trimester scan (Figure 1). However, we agree that a comprehensive fetal echocardiography should be performed when heart anomalies are suspected. One of the problems to follow this guideline is the difficulty of obtaining images of the outflow tracts. This happens because unlike the four-chamber view, the aorta and pulmonary artery do not lie in a single axis. In

Prenatal Detection of Congenital Heart Diseases: One-Year Survey Performing a Screening Protocol in a Single Reference Center in Brazil

Objective. To describe the experience of a tertiary center in Brazil to which patients are referred whose fetuses are at increased risk for congenital heart diseases (CHDs). Methods. This was a cross-sectional observational study. The data was collected prospectively, during the year 2012, through a screening protocol of the fetal heart adapted from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guideline. We performed a fetal echocardiogram screening for all pregnant women who were referred to the fetal cardiology outpatient obstetrics clinic of a university hospital. The exams were classified as normal or abnormal. The cases considered abnormal were undergone to a postnatal echocardiogram. We categorized the abnormal fetal heart according to severity in “complex,” “significant,” “minor,” and “others.” Results. We performed 271 fetal heart screening. The incidence of abnormal screenings was 9.96% (27 fetuses). The structural CHD when categorized due to severity showed 48.1% (n = 13) of “complex” cases, 18.5% (n = 5) “significant” cases, and 7.4% (n = 2) “minor” cases. The most common referral reason was by maternal causes (67%) followed by fetal causes (33%). The main referral indication was maternal metabolic disease (30%), but there was just one fetus with CHD in such cases (1.2%). CHDs were found in 19/29 fetuses with suspicion of some cardiac abnormality by obstetrician (65.5%). Conclusion. We observed a high rate of CHD in our population. We also found that there was higher incidence of complex cases.

Reference values for the volumes of foetal heart atrial wall by three-dimensional ultrasound using STIC and VOCAL methods between 20w0d and 33w6d weeks of gestation.

Abstract Objective: To establish reference values for the volumes of foetal heart atrial wall by three-dimensional (3D) ultrasound using spatio-temporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL) methods. Methods: We performed a retrospective cross-sectional study with 170 normal singleton pregnancies between 20 weeks + 0 days (20w0d) and 33 weeks + 6 days (33w6d) of gestation. Foetal heart atrial wall volume was obtained by VOCAL method with 30-degree rotation (six planes) subtracting the internal volume from the atrium volume. Polynomial regression with adjustments by determination coefficient (R2) was performed. To calculate the interobserver reproducibility, concordance correlation coefficient (CCC) was applied. Results: The mean ± standard deviation (SD) for the left atrium wall volume (cm3) ranged from 0.54 ± 0.21 at 20w0d–20w6d to 2.17 ± 0.30 at 33w0d–33w6d. The mean ± SD for the right atrium wall volume (cm3) ranged from 0.45 ± 0.16 at 20w0d–20w6d to 2.17 ± 0.62 at 33w0d–33w6d. We observed a satisfactory interobserver reproducibility with CCC = 0.69 and 0.58 for the left and right volumes of foetal heart atrial wall, respectively. The best-fit models were first-degree: volume for the left atrium wall = −2.194 + 0.139*GA (R2 = 0.41) and volume for the right atrium wall = −2.757 + 0.155*GA (R2 = 0.37). Conclusion: Reference values for the volumes of foetal heart atrial wall by 3D ultrasound using STIC and VOCAL methods between 20w0d and 33w6d weeks of gestation were established.