Oggè G, Gaglioti P, Maccanti S, Faggiano F, Todros T
Department of Obstetrics and Gynaecology, University of Turin, Turin, Italy.
Ultrasound Obstet Gynecol. 2006 Nov;28(6):779-84. doi: 10.1002/uog.3830.
Congenital heart diseases (CHD) are the most common congenital anomalies, and most cases occur in the low-risk population. Prenatal ultrasound screening based on visualization of the four-chamber view has had disappointing results in detecting these anomalies thus far. The aim of this study was to evaluate the diagnostic accuracy of ultrasound screening based on the combination of the four-chamber and outflow-tract views.
We conducted a multicenter prospective observational study in 15 obstetric units in the Piedmont Region, Italy. All operators received specific training. Data were recorded regarding visualization of the four-chamber view and the outflow tracts at each routine scan in pregnancies without any risk factor. When an anomaly was suspected, the patient was sent to the referral center. We obtained the follow-up data of the newborns until discharge from hospital and calculated the diagnostic accuracy of the test.
9074 ultrasound scans were performed on 7041 women and complete follow-up information was available for 6368 of them. Fifty-eight cases of CHD were observed at birth or postmortem (prevalence 9.1 per thousand); 38 of them were diagnosed in utero. The sensitivity of the test was 65.5%, the specificity 99.7%, the positive predictive value 70.4% and the negative predictive value 99.7%. The sensitivity of the four-chamber view alone was 60.3%.
The sensitivity was significantly higher than that in a similar study performed in 1997 in the same setting. This improvement can be attributed in part to extension of the examination to the outflow-tract view, but also to technological developments and better training of the operators.
先天性心脏病（CHD）是最常见的先天性畸形，大多数病例发生在低风险人群中。迄今为止，基于四腔心切面可视化的产前超声筛查在检测这些畸形方面效果不佳。本研究的目的是评估基于四腔心和流出道切面联合观察的超声筛查的诊断准确性。
我们在意大利皮埃蒙特地区的15个产科单位进行了一项多中心前瞻性观察研究。所有操作人员均接受了专门培训。记录了无任何危险因素的妊娠每次常规扫描时四腔心切面和流出道的可视化情况。当怀疑有畸形时，患者被送往转诊中心。我们获得了新生儿直至出院的随访数据，并计算了该检查的诊断准确性。
对7041名女性进行了9074次超声扫描，其中6368名有完整的随访信息。出生时或尸检时观察到58例先天性心脏病（患病率为千分之9.1）；其中38例在子宫内被诊断出。该检查的敏感性为65.5%，特异性为99.7%，阳性预测值为70.4%，阴性预测值为99.7%。仅四腔心切面的敏感性为60.3%。
敏感性显著高于1997年在相同环境下进行的类似研究。这种提高部分可归因于将检查扩展到流出道切面，也归因于技术发展和操作人员更好的培训。
