title: Accuracy of fetal echocardiography: a cardiac segment-specific analysis.
abstract: OBJECTIVE
  In patients with congenital heart disease, comprehensive, segment-specific analysis of cardiac anatomy has become 'the standard of care', largely as a result of improvements in cardiac imaging technology. Our aim was to apply segment-specific standards to assess the accuracy of fetal echocardiography.
  
  
  METHODS
  This was a retrospective review of all fetal echocardiograms (n = 915) performed at our center between August 1998 and June 2003. Of these, 100 studies had congenital heart disease findings and corresponding postnatal studies on the same patients for comparison. An expert independent pediatric echocardiologist, using the standards of accuracy expected of postnatal echocardiography, assessed the studies for the following cardiac segments: abdominal situs, systemic venous return (VR), pulmonary VR, atria, atrioventricular valves, ventricular septum, ventricular hypoplasia, ventricular morphology, semilunar valves, great arterial relation and aortic arch. Sensitivity, specificity, and positive and negative predictive values were calculated for each segment.
  
  
  RESULTS
  Specificity and negative predictive value were high for all cardiac segments (range, 82-100%). Sensitivity and positive predictive value were similarly high (range, 83-100%) for most cardiac segments, but were only 50-88% for systemic VR, pulmonary VR and aortic arch segments.
  
  
  CONCLUSIONS
  Fetal echocardiography has excellent diagnostic accuracy in describing intracardiac anatomy. However, despite both technological advances and improved physician awareness, assessment of systemic VR, pulmonary VR, and aortic arch anatomy remain challenging.
authors.affiliation: Fetal Heart Program, Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. bill.gottliebson@cchmc.org
authors.forename: W M
authors.initials: WM
authors.lastname: Gottliebson
authors.forename: W L
authors.initials: WL
authors.lastname: Border
authors.forename: C M
authors.initials: CM
authors.lastname: Franklin
authors.forename: R A
authors.initials: RA
authors.lastname: Meyer
authors.forename: E C
authors.initials: EC
authors.lastname: Michelfelder
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D004452:Echocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D011237:Predictive Value of Tests; D011247:Pregnancy; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal