The value of multiple 2D ultrasound scanning views in the detection of Congenital Heart Disease in the second trimester (18 to 24 weeks)

Abstract

Antenatal detection for Congenital Heart Disease (CHD) is poor, but may be improved by adding views to routine ultrasound scanning. From June 2014-July 2015, 600 randomly selected women between 18 to 24 weeks of pregnancy, had a routine 4-chamber ultrasound scan at Mater Dei Hospital view (Basic 4CV). In addition, they completed an Extended Cardiac Ultrasound Examination (ExCUSE) including the left outflow tract, right outflow tract, 5-chamber view and 3-vessel view. All views were timed. The results obtained from the 600 women who received Basic and the ExCUSE scanning were followed-up clinically after delivery of the infants. Validity testing of both 4CV and ExCUSE views was carried out, and the detection rate of CHD compared. During the 12-month period, 61 cases from a total of 4,200 children up to 1 year of age were diagnosed with CHD by Paediatric Echocardiography. 19 were included in the 600-study cohort, of which 12 were detected antenatally, 1 via the 4CV alone, 4 by both the 4CV plus at least 1 of the ExCUSE views and 7 by 1 or more of the ExCUSE views alone. On average, ExCUSE views took approximately 6 minutes longer, yet there was a significant difference between the detection rate of CHD by the 4CV compared with the ExCUSE views (χ2 = 0.031, p=0.05). Sensitivity and specificity of the 4CV were 31.6% and 100%, respectively, and 63.1% and 100%, respectively for ExCUSE views. Antenatal diagnosis of CHD is improved with additional ultrasound views, but this will necessitate staff training and adjustments in clinic schedules to accommodate increased scan time.