title: Area of the fetal heart's four-chamber view: a practical screening tool to improve detection of cardiac abnormalities in a low-risk population.
abstract: OBJECTIVE
  The objective of this article is to evaluate whether the area of the four-chamber view of the fetal heart computed from two orthogonal diameters could be used to screen for cardiac malformations.
  
  
  METHODS
  Two hundred control fetuses were examined between 20 and 40 weeks of gestation. The end-diastolic area was computed from the orthogonal basal-apical and transverse diameters obtained from the four-chamber view. Regression analysis of the computed area versus six independent variables was performed between 20 and 40 weeks. Fetuses with major heart defects were identified from a low-risk population of 4352 fetuses undergoing second-trimester or third-trimester screening ultrasound. The end-diastolic area was derived and the Z-score and centile computed. An area greater than the 95th centile was considered to be abnormal.
  
  
  RESULTS
  From the screening population, the incidence of major heart defects was 2.8/1000. Of the 12 fetuses with major heart defects, 50% (6/12) demonstrated an area greater than the 95th centile. Of the fetuses with an enlarged heart, 66% (4/6) had outflow tract abnormalities.
  
  
  CONCLUSIONS
  Measurements of the orthogonal basal-apical and transverse diameters can be used to compute the area of the four-chamber view. Fetuses with major heart defects who have an enlarged heart can be identified using this technique. © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.|Fetal Diagnostic Centers, Pasadena, Tarzana, Lancaster, CA, USA.
authors.forename: Greggory R
authors.initials: GR
authors.lastname: DeVore
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Mattel Children's Hospital UCLA, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Satou
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Mattel Children's Hospital UCLA, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Sklansky
mesh_terms: D001837:Body Weights and Measures; D005260:Female; D005318:Fetal Heart / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000175:diagnosis*; D006801:Humans; D009929:Organ Size; D011247:Pregnancy; D012107:Research Design; D016216:Ultrasonography, Prenatal / Q000379:methods*