Addition of color Doppler to the routine obstetric sonographic survey aids in the detection of pulmonic stenosis.
OBJECTIVE
Most fetuses with congenital heart disease (CHD) occur in women that are not at increased risk, and since it is impractical to perform detailed fetal echocardiography on everyone, detection of CHD relies mainly on routine second trimester fetal anatomic surveys. We therefore attempted to improve the detection rate of CHD at the time of routine second trimester obstetrical sonography in low-risk patients.


METHODS
This was a retrospective review of an 18-month period in which color Doppler was added to the standard grey scale evaluation of the fetal heart at the time of our routine second trimester anatomic surveys that we performed on fetuses at low risk for CHD. Cases in which CHD was suspected were reviewed with special attention to those in which abnormalities on color Doppler were the primary finding.


RESULTS
CHD was suspected in 17 of 1,766 (1%) routine fetal anatomic surveys that we performed between 16 and 22 weeks. There were 13 cases with findings on grey scale, and 4 cases (24%) that relied on findings with color Doppler, as the grey scale evaluation was normal or near normal. Of these 4 cases, 3 had critical pulmonic stenosis requiring balloon valvuloplasty shortly after birth; the fourth case had a mildly dysplastic pulmonic valve that did not require intervention in the immediate newborn period.


CONCLUSIONS
The addition of color Doppler evaluation of the fetal heart to routine obstetrical sonographic structural surveys in low-risk patients aids in the detection of pulmonic stenosis.
Nadel
Allan S
AS
Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, USA. anadel@partners.org
D002404:Catheterization; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011666:Pulmonary Valve Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery; D012189:Retrospective Studies; D018615:Ultrasonography, Doppler, Color; D016216:Ultrasonography, Prenatal