Utility of fetal magnetic resonance imaging in assessing the fetus with cardiac malposition.
OBJECTIVE
Abnormal cardiac axis and/or malposition prompts evaluation of congenital heart disease; however, etiology may be difficult to clarify using obstetrical ultrasound or fetal echocardiography (echo) alone. We aimed to use fetal magnetic resonance imaging (MRI) as a complementary tool to identify causes of cardiac malposition.


METHODS
Review of fetuses diagnosed with cardiac malposition by fetal ultrasound and echo was performed. Etiology was classified as either because of heterotaxy syndrome or extracardiac masses. Reclassification was then performed with fetal MRI findings. Results were compared with postnatal diagnoses.


RESULTS
Forty-two fetuses were identified as having abnormal cardiac axis and/or malposition. Twenty three of 42 cases (55%) had extracardiac anomalies, while 19 (45%) were because of heterotaxy. Twelve of 42 (29%) cases were reassigned by fetal MRI (five in heterotaxy group and seven in the lung anomaly group). Four cases (33%) had both cardiac disease and extracardiac masses, not previously recognized. Fetal MRI clarified heterotaxy subtype or removed heterotaxy diagnosis in five (26%) patients. Fetal MRI findings were confirmed in 8 of these 12 cases postnatally.


CONCLUSIONS
Fetal MRI is a useful complementary tool to define etiology of cardiac malposition in complex cases for informative prenatal counseling and planning. © 2016 John Wiley & Sons, Ltd.
Division of Cardiology/Taussig Heart Center, Bloomberg Children's Center, Johns Hopkins Medical Institution, Baltimore, MD, USA.
Lasya
L
Gaur
Division of Cardiology, Children's National Medical Center, Washington, DC, USA.
Lauren
L
Talemal
Division of Radiology, Children's National Medical Center, Washington, DC, USA.
Dorothy
D
Bulas
Division of Cardiology, Children's National Medical Center, Washington, DC, USA.
Mary T
MT
Donofrio
D000328:Adult; D004452:Echocardiography; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000209:etiology; D059446:Heterotaxy Syndrome / Q000000981:diagnostic imaging*; D006801:Humans; D008168:Lung / Q000002:abnormalities / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D011296:Prenatal Diagnosis; D015619:Respiratory System Abnormalities / Q000150:complications / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal