The July issue of Ultrasound in Obstetrics & Gynecology is a Special Issue on Congenital Heart disease, produced in collaboration with ISUOG’s ongoing global initiative, Every Little Heart Matters, and curated by UOG Editors Prof. Anita Moon-Grady and Dr Taisto Sarkola. This issue includes an evaluation of the Danish prenatal screening program for detection and outcomes of major fetal CHDs, an assessment of the risk of minor CHD in infants conceived via assisted reproductive technology, a registry based case–cohort study investigating outcome of fetal cardiac intervention in hydropic fetuses with CHD and a How To article from the Fetal Heart Society on assessment of ventricular function by fetal echocardiography.
Please see below a selection of articles from the July issue of the Journal chosen specially by the UOG team. To view all UOG content, become an ISUOG member today or login and upgrade.
Prenatal detection and outcome of major heart defects in a country with universal screening
Prenatal detection of major congenital heart defects (mCHD) may reduce the risk of morbidity and mortality by enabling clinicians optimize perinatal planning and deliver specialized care at birth. In this nationwide study, following the centralization of pediatric cardiothoracic surgery and the establishment of a nationwide interdisciplinary collaboration on fetal mCHD, Vedel et al. evaluated the Danish universal prenatal screening program. Specifically, they assessed the prenatal detection rate for mCHD, liveborn incidence, pregnancy outcome and postnatal mortality. Their findings demonstrated increased prenatal detection rates, a declining liveborn incidence of mCHD and low postnatal mortality in Denmark, underscoring the efficacy of the national screening program and centralised care.
Risk of minor congenital heart defect in infants conceived via assisted reproductive technology: cohort study from the Copenhagen Baby Heart Study
Assisted reproductive technology (ART) now accounts for the conception of up to 9.0% of births in Europe and 5.1% in the USA, with over 10 million individuals conceived through ART worldwide. Although previous studies have linked ART to a higher risk of major congenital heart defects (CHD), the association with minor CHD remains unclear. To address this knowledge gap, Kyhl-Svart et al. compared the prevalence and risk of minor CHD in singleton infants conceived via ART with those in matched spontaneously conceived infants. They found no significant differences in the overall risk of minor CHD, including ventricular septal defect, bicuspid aortic valve and atrial septal defect, or in the risk of individual minor CHD subtypes between the two groups. These findings provide reassuring evidence that ART is not associated with an increased risk of minor CHD in singleton infants and suggest that ART is unlikely to impose an increased long-term cardiovascular risk.
Invasive in-utero cardiac intervention in the hydropic fetus may improve survival: results from the International Fetal Cardiac Intervention Registry (IFCIR)
Fetal cardiac intervention (FCI) has been proposed as a ‘rescue’ therapy to improve hemodynamics in selected fetuses with congenital heart disease (CHD) complicated by hydrops, despite this condition being associated with a poor prognosis. However, to date, no large, prospective series informing the outcomes of FCI in hydropic fetuses has been published. In this registry-based case–cohort study, Moon-Grady et al. use data from the International Fetal Cardiac Intervention Registry to report on a large series of pregnancies to better understand pregnancy and postnatal outcomes after FCI in fetuses with hydrops and CHD. Their findings suggest a potential benefit of FCI in patients with hydrops, with approximately one-third of hydropic fetuses that underwent FCI surviving to hospital discharge, although the procedure-related loss rate of 1 in 5 was significant. The authors suggest that expectant parents should be counseled appropriately regarding both the poor prognosis without performing a FCI procedure and the potential for an improved chance of survival after FCI, despite the risk of fetal loss.
How to assess ventricular function by fetal echocardiography: expert guidance from the Fetal Heart Society
Assessment of ventricular function is a key component of fetal cardiac evaluation and while it may be sufficient in most routine examinations to confirm the absence of cardiomegaly or atrioventricular valve regurgitation, together with a qualitative assessment of ventricular systolic function and Doppler evaluation of ventricular filling and central venous pressure, more comprehensive quantitative measures are particularly important in fetuses at risk of ventricular dysfunction. Accurate prenatal assessment of ventricular function is essential for planning surveillance, delivery and resource needs and this ‘How To’ article from the Fetal Heart Society outlines a step-by-step approach for evaluating fetal ventricular function using echocardiography. The article covers assessment of systolic function, including ventricular shortening fraction, annular plane systolic excursion, ejection fraction and fractional area change, as well as diastolic function, cardiac output and the myocardial performance index. It also introduces experimental and emerging modalities, such as cardiac deformation and strain imaging and three-dimensional volumetric assessment. Supported by figures and accompanying videos, this practical guide by Patel et al. serves as a valuable resource for clinicians performing fetal echocardiography.
This issue features the latest high-impact research on congenital heart disease, and there is much more to discover than the selection above, the prenatal presentation of fetal bradycardia and long QT syndrome, as well as specially commissioned opinion and how to articles on topics such as the basic assessment of the fetal heart in low-resource settings and a step-by-step guide on how to apply the DAZE technique to optimise fetal cardiac imaging. The selection of articles included in this issue are intended to help stimulate future high-quality research, better diagnostic and therapeutic decisions and improvement in prenatal detection and care around the world, in alignment with the goals and objectives of the Every Little Heart Matters campaign.
Prof. Katia Bilardo, Chair of the Every Little Heart Matters Oversight Group, said: "Among the activities related to our ELHM initiative, we are pleased to announce that a special edition of UOG will be entirely dedicated to the fetal heart. Leading experts will share their knowledge in a number of key articles on state-of-the-art research regarding screening and diagnosis of congenital heart disease. We invite you to read this important issue and share this information with your peers. Remember that Every Little Heart Matters!"
Please make sure to check out the rest of the issue, which can be found here.