title: Prenatal examination of the area and morphology of the atrioventricular valves using four-dimensional ultrasound in normal and abnormal hearts.
abstract: OBJECTIVE
  Our aim is to evaluate the feasibility to examine the morphology and area of the atrioventricular (AV) valves in normal fetuses and fetuses with cardiac defects using spatiotemporal image correlation (STIC).
  
  
  METHODS
  Atrioventricular valves were analyzed longitudinally in STIC volumes of 74 normal fetuses between the 15th and 36th week of pregnancy. The valve area was measured in a rendered view in diastole, the number of valve leaflets in systole. Longitudinal data analysis was performed using linear mixed models. Fifty fetuses with cardiac defects were examined.
  
  
  RESULTS
  Examination of 355 STIC volumes of normal fetuses showed in 82.5% sufficient quality. The tricuspid valve leaflets were seen in 200 (68.3%) volumes and the mitral valve leaflets in 219 (74.7%) volumes. The tricuspid valve showed in 61.1% a round, 29.0% rectangle, and 8.9% elliptical shape and the mitral valve in 60.1% round, 28.0% rectangle, and 10.9% elliptical. Regression analysis revealed a positive relationship of the valve area with gestational age (p < 0.0001). Most heart defects with stenosis showed an area below the 5th percentile.
  
  
  CONCLUSIONS
  Prenatal examination of the morphology and area of the AV valves using four-dimensional ultrasound is feasible. A rectangular valve opening is normal, which was visualized in about one third of the normal fetuses.
authors.affiliation: Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: B M E
authors.identifier: http://orcid.org/0000-0001-6541-0826
authors.initials: BM
authors.lastname: Adriaanse
authors.affiliation: Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: L B
authors.initials: LB
authors.lastname: Uittenbogaard
authors.affiliation: Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: C H N
authors.initials: CH
authors.lastname: Tromp
authors.affiliation: Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: S S
authors.initials: SS
authors.lastname: Schaefer
authors.affiliation: Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: M W
authors.initials: MW
authors.lastname: Heymans
authors.affiliation: Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: J M G
authors.initials: JM
authors.lastname: van Vugt
authors.affiliation: Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: M C
authors.initials: MC
authors.lastname: Haak
mesh_terms: D016022:Case-Control Studies; D019561:Echocardiography, Four-Dimensional; D005240:Feasibility Studies; D005260:Female; D005318:Fetal Heart / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000196:embryology; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000196:embryology; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008943:Mitral Valve / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000196:embryology; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D012016:Reference Values; D062211:Spatio-Temporal Analysis; D014261:Tricuspid Valve / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000196:embryology; D016216:Ultrasonography, Prenatal / Q000379:methods*