title: Prenatal Visualization of the Pulmonary and Aortic Valves and Leaflets Is Feasible Using 4-Dimensional Sonography.
abstract: OBJECTIVE
  The purpose of this study was to determine whether the morphologic characteristics and area of the semilunar valves in healthy fetuses and fetuses with cardiac defects can be visualized by using spatiotemporal image correlation (STIC).
  
  
  METHODS
  Spatiotemporal image correlation volumes from 74 healthy fetuses were recorded in 5 examinations between the 15th and 36th weeks of pregnancy. Second, we recorded STIC volumes from 64 fetuses with various cardiac defects. The quality of the volumes was rated. The areas of the aortic and pulmonary valves were measured in systole by rendering the valves on 4-dimensional sonography. The number of leaflets was examined. Longitudinal data analysis using linear mixed models was performed.
  
  
  RESULTS
  Two hundred ninety-three volumes from normal hearts were examined. In 82.5%, the quality of the normal volumes was sufficient. Visualization of the valve opening was feasible in 96.1% of the normal hearts and 97.4% of the abnormal hearts. The success rate of visualization of the pulmonary and aortic valve leaflets was dependent on the gestational age, with the highest percentage (72.1% in normal hearts) at 19 to 24 weeks. Longitudinal regression analysis showed a positive relationship of the aortic and pulmonary valve areas with gestational age (P < .0001) and fetal biometric measurements (P < .0001). Fifty-eight abnormal volumes were examined. Cardiac defects with abnormal valve areas due to aortic and pulmonary stenosis could be clearly visualized by using STIC.
  
  
  CONCLUSIONS
  Examination of the morphologic characteristics of the semilunar valves using STIC is feasible, which is difficult when using 2-dimensional sonography. With increasing implementation of 4-dimensional sonography, the understanding of rendered images might be useful for anyone practicing fetal echocardiography.
authors.affiliation: Departments of Obstetrics and Gynecology (B.M.E.A., L.B.U., C.H.N.T.) and Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, the Netherlands; Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands (J.M.G.v.V.); and Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands (M.C.H.). b.adriaanse@vumc.nl.
authors.forename: Bauke M E
authors.initials: BM
authors.lastname: Adriaanse
authors.affiliation: Departments of Obstetrics and Gynecology (B.M.E.A., L.B.U., C.H.N.T.) and Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, the Netherlands; Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands (J.M.G.v.V.); and Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands (M.C.H.).
authors.forename: Lukas B
authors.initials: LB
authors.lastname: Uittenbogaard
authors.affiliation: Departments of Obstetrics and Gynecology (B.M.E.A., L.B.U., C.H.N.T.) and Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, the Netherlands; Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands (J.M.G.v.V.); and Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands (M.C.H.).
authors.forename: Chantal H N
authors.initials: CH
authors.lastname: Tromp
authors.affiliation: Departments of Obstetrics and Gynecology (B.M.E.A., L.B.U., C.H.N.T.) and Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, the Netherlands; Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands (J.M.G.v.V.); and Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands (M.C.H.).
authors.forename: Martijn W
authors.initials: MW
authors.lastname: Heymans
authors.affiliation: Departments of Obstetrics and Gynecology (B.M.E.A., L.B.U., C.H.N.T.) and Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, the Netherlands; Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands (J.M.G.v.V.); and Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands (M.C.H.).
authors.forename: John M G
authors.initials: JM
authors.lastname: van Vugt
authors.affiliation: Departments of Obstetrics and Gynecology (B.M.E.A., L.B.U., C.H.N.T.) and Epidemiology and Biostatistics (M.W.H.), VU University Medical Center, Amsterdam, the Netherlands; Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands (J.M.G.v.V.); and Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands (M.C.H.).
authors.forename: Monique C
authors.initials: MC
authors.lastname: Haak
mesh_terms: D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging* / Q000196:embryology; D019561:Echocardiography, Four-Dimensional / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008297:Male; D011664:Pulmonary Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging* / Q000196:embryology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal / Q000379:methods*
keywords: 4-dimensional sonography; aortic valve; fetal echocardiography; fetus; prenatal diagnosis; pulmonary valve; spatiotemporal image correlation