Rustico M A, Benettoni A, D'Ottavio G, Fischer-Tamaro L, Conoscenti G C, Meir Y, Natale R, Bussani R, Mandruzzato G P
Divisione di Ostetricia e Ginecologia, Istituto per l'Infanzia via dell'Istria 65/1, 34100 Trieste, Italy.
Ultrasound Obstet Gynecol. 2000 Dec;16(7):614-9. doi: 10.1046/j.1469-0705.2000.00291.x.
To examine the accuracy of early transvaginal fetal echocardiography performed in an unselected population by operators with different levels of experience and to compare the results with those obtained from a referral population.
Prospective study.
A series of 4785 unselected fetuses and 221 referred fetuses were screened at 13-15 weeks' gestational age by transvaginal echocardiography. For each fetus, visualization of the four-chamber view plus the origin of the great arteries was attempted. Color Doppler imaging was only performed in cases of cardiac malformations already identified by two-dimensional echocardiography. The scans were performed by seven operators with different levels of experience. Reliability was assessed by conventional transabdominal echocardiography at 20-22 weeks, by postnatal follow-up in the first 3 months of life, and/or by autopsy in all cases of termination or fetal death.
The rate of complete visualization (four-chamber view plus great arteries) was 47.5% in the unselected population, and 76.9% in the referral population. There were four (0.08%) true positives among the unselected fetuses, and five (2.3%) among referrals, mostly with enlarged nuchal translucency or other malformations. Among the unselected fetuses, nine false negatives were detected by transabdominal echocardiography. Improvement in the operators' ability to recognize cardiac anomalies in unselected population was disappointing and was influenced more by individual approach than by the number of examinations performed.
Early screening for cardiac anomalies among unselected fetuses is ill-advisable. The usefulness of an early approach is confirmed in high risk fetuses or in the presence of enlarged nuchal translucency when performed by expert operators.
研究不同经验水平的操作者对未经筛选人群进行早期经阴道胎儿超声心动图检查的准确性，并将结果与转诊人群的检查结果进行比较。
前瞻性研究。
在孕13 - 15周时，对4785例未经筛选的胎儿和221例转诊胎儿进行经阴道超声心动图检查。对每个胎儿，尝试观察四腔心切面及大动脉起源。仅在二维超声心动图已确定有心脏畸形的情况下进行彩色多普勒成像。扫描由7名经验水平不同的操作者完成。通过在孕20 - 22周进行常规经腹超声心动图检查、出生后前3个月的随访以及/或者在所有终止妊娠或胎儿死亡病例中进行尸检来评估可靠性。
未经筛选人群中完全观察到（四腔心切面加大动脉）的比例为47.5%，转诊人群中为76.9%。未经筛选的胎儿中有4例（0.08%）为真阳性，转诊胎儿中有5例（2.3%）为真阳性，大多数伴有颈项透明层增厚或其他畸形。在未经筛选的胎儿中，经腹超声心动图检测到9例假阴性。未经筛选人群中操作者识别心脏异常能力的提高令人失望，更多地受个人方法影响而非检查次数影响。
对未经筛选的胎儿进行心脏异常早期筛查是不可取的。由专业操作者对高危胎儿或存在颈项透明层增厚的胎儿进行早期检查的有效性得到证实。
