Fetal Cardiac Axis in Fetuses with Conotruncal Anomalies

Abstract

Purpose The purpose of this study was to assess the cardiac axis in fetuses with conotruncal anomalies during four-chamber view scanning.

Materials and Methods We retrospectively evaluated the cardiac axis of 150 fetuses with conotruncal anomalies within the second and third trimester between October 2008 and August 2014. The cardiac axis was obtained by the angle of two lines in a transverse view of the fetal thorax at the level of the four-chamber view. The first line divided the thorax into two equal halves starting from the spine posteriorly ending at the sternum. The second line was placed through the interventricular septum of the fetal heart. The angle was calculated using OsiriX software.

Results 23 had double outlet right ventricle (DORV), 17 had truncus arteriosus communis (TAC), 36 had tetralogy of Fallot (TOF), and 74 had complete transposition of the great arteries (d-TGA). In fetuses with DORV ≤ 24 + 6 weeks of gestation (wks), the mean cardiac axis was 52.5° (p = 0.005), at ≥ 25 + 0 wks it was 51.1° (p = 0.0003). In fetuses with TAC ≤ 24 + 6 wks, the mean cardiac axis was 56.8° (p = 0.01), at ≥ 25 + 0 wks it was 50.0° (p = 0.05). In fetuses with TOF ≤ 24 + 6 wks, the mean cardiac axis was 67.5° (p < 0.0001), at ≥ 25 + 0 wks it was 63.8° (p < 0.0001). In fetuses with d-TGA ≤ 24 + 6 wks, the mean cardiac axis was 45.6°, at ≥ 25 + 0 wks it was 45.4° (not significant). Throughout gestation, the cardiac axis did not show a difference in the two separate examinations.

Conclusion In fetuses with DORV, TAC and TOF, the cardiac axis is significantly different from the normal axis, but in fetuses with TGA there is no significant difference compared to the normal axis. Therefore, analysis of the heart axis could be useful for screening for conotruncal anomalies.

Zusammenfassung

Ziel Bestimmung der fetalen Herzachse im Vierkammerblick bei Feten mit konotrunkalen Anomalien.

Material und Methoden Retrospektive Analyse von 150 Feten mit konotrunkalen Anomalien im zweiten und dritten Trimenon im Zeitraum von Oktober 2008-August 2014. Die Herzachse wurde bestimmt als Winkel zwischen einer Medianlinie durch den Thorax von der Wirbelsäule bis zum Sternum sowie einer zweiten Linie entlang der kardialen Achse durch das Ventrikelseptum. Die Winkelberechnungen erfolgten mittels OsiriX-Software.

Ergebnisse 23 Feten mit Double Outlet Right Ventricle (DORV), 17 mit Truncus arteriosus communis (TAC), 36 mit Fallot-Tetralogie (TOF) und 74 mit Transposition der großen Arterien (d-TGA) wurden untersucht. Bei Feten mit DORV vor 24 + 6 Schwangerschaftswochen (SSW) betrug die Herzachse im Mittel 52,5° (p = 0,005), und nach 25 + 0 SSW 51,1° (p = 0,0003). Bei Feten mit TAC vor 24 + 6 SSW betrug die Herzachse im Mittel 56,8° (p = 0,01) und nach 25 + 0 SSW 50,0° (p = 0,05). Bei Feten mit TOF vor 24 + 6 SSW betrug die Achse im Mittel 67,5° (p < 0,0001), danach 63,8° (p < 0,0001). Bei Feten mit d-TGA vor 24 + 6 SSW betrug die Achse im Mittel 45,6°, nach 25 + 0 SSW 45,4° (nicht signifikant). Im Schwangerschaftsverlauf zeigten sich keine Veränderungen der Herzachse der untersuchten Feten.

Schlussfolgerung Bei Feten mit DORV, TAC und TOF weicht die fetale Herzachse signifikant von der normalen Herzachse ab. Bei Feten mit d-TGA zeigte sich keine Veränderung. Die Analyse der fetalen Herzachse könnte als Screening-Instrument für konotrunkale Anomalien in der Basisuntersuchung des Herzens sinnvoll sein.

Key words

echocardiography - fetal - cardiac axis

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