title: Identification of fetal cardiac anatomy and hemodynamics: a novel enhanced screening protocol.
abstract: Prenatal cardiac screening is of great importance as it contributes to appropriate neonatal management and helps parents to make a decision regarding their pregnancy. The aim of our study was to evaluate the efficiency of a newly proposed screening protocol in the detection of fetal congenital heart disease (CHD).
  
  
  
  This was a prospective study. A total of 52 cases of confirmed CHD fetuses and 248 cases of randomly selected normal fetuses were included in the study. Two sonographers with similar experience performed the cardiac screenings under two different protocols independently. The conventional protocol (Protocol A) paid greater attention to the four-chamber view and the outflow tract views. A 6-month training program was provided to sonographers performing scans under the new protocol (Protocol B), which emphasized systematically evaluating fetal cardiac anatomy and hemodynamics. Color Doppler was mandatory and some ultrasonic signs for special cardiac anomalies were also introduced into this protocol.
  
  
  
  Protocol B detected more cardiac anomalies than did Protocol A (96.2 % vs. 61.5 %, P < 0.01). Specifically, Protocol B was superior to Protocol A in detecting cardiac malpositions, abnormal systemic and pulmonary venous connection, right aortic arch, transposition of the great arteries, and congenital corrected transposition of the great arteries. By visualizing flow disturbance and retrograde flow with color Doppler, Protocol B was better than Protocol A in screening valvular associated malformations, such as pulmonary atresia, pulmonary stenosis, tricuspid dysplasia, etc. For the normal fetuses, Protocol B was better than Protocol A in reducing the false-positive detection of septal defects.
  
  
  
  The current study introduces an enhanced protocol for fetal cardiac screening, under which the obstetric screening sonographers systematically identify fetal cardiac anatomy and hemodynamics. A short-term training program makes it possible for the screening sonographers to become familiar with the new protocol, and its value has been confirmed due to improvements made in screening efficiency.
authors.affiliation: Department of Sonography, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, Liaoning, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Sonography, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, Liaoning, China.
authors.forename: Ai-Lu
authors.initials: AL
authors.lastname: Cai
authors.affiliation: Department of Sonography, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, Liaoning, China.
authors.forename: Wei-Dong
authors.initials: WD
authors.lastname: Ren
authors.affiliation: Department of Sonography, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, Liaoning, China.
authors.forename: Ya-Jun
authors.initials: YJ
authors.lastname: Guo
authors.affiliation: Department of Sonography, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, Liaoning, China.
authors.forename: Dong-Yu
authors.initials: DY
authors.lastname: Zhang
authors.affiliation: Department of Sonography, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, Liaoning, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Sun
authors.affiliation: Department of Sonography, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, Liaoning, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Sonography, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, Liaoning, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Sonography, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, Liaoning, China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Qin
authors.affiliation: Department of Sonography, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, Liaoning, China. lipinghuang0210@sina.com.
authors.forename: Li-Ping
authors.initials: LP
authors.lastname: Huang
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002985:Clinical Protocols; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005188:False Negative Reactions; D005260:Female; D005318:Fetal Heart / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000196:embryology; D006439:Hemodynamics; D006801:Humans; D011247:Pregnancy; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal / Q000379:methods*
keywords: Cardiac screening; Congenital heart disease; Fetal echocardiography; Prenatal diagnosis; Segmental analysis