Real-time 3-dimensional echocardiographic assessment of ventricular volume, mass, and function in human fetuses.

OBJECTIVES: We sought to determine the feasibility and reproducibility of real-time 3-dimensional echocardiography (RT3DE) for evaluation of cardiac volume, mass, and function and to characterize maturational changes of these measurements in human fetuses. METHODS: Eighty pregnant women in the 2(nd) and 3(rd) trimesters (59 with normal fetuses and 21 with fetuses with congenital heart disease [CHD]) were enrolled. We acquired RT3DE images using a matrix-array transducer. RT3DE measurements of volume, mass, stroke volume (SV), combined cardiac output (CCO), and ejection fraction (EF) were obtained. Images were scored and analyzed by two blinded independent observers. Inter- and intraobserver variabilities and correlations between fetal cardiac indices and gestational age were determined. RESULTS: Fifty-two of 59 normal data sets (88%) and 9 of 21 CHD data sets (43%) were feasible for analysis. In normal fetuses, the right ventricle (RV) is larger than the left ventricle (LV) (P<0.05), but no difference exists between the LV and RV in mass, SV, CO, and CO/CCO. The EFs for the LV and RV were diminished; the RVSV/LVSV was reduced in CHD fetuses compared with normal fetuses (P<0.05). Fetal ventricular volumes, mass, SV, and CCO fit best into exponential curves with gestational age, but LVEF, RVEF, and RVSV/LVSV remain relatively constant. CONCLUSIONS: RT3DE is feasible and reproducible for assessment of LV and RV volume, mass, and function, especially in normal fetuses. Gestational growth of these measures, except for EF, is exponential in normal and CHD fetuses. CHD fetuses exhibit diminished LV and RV EFs

RV volume analysis by RT3DE image package.

<p>Left, the 3D data displayed in sagittal, 4-chamber, and coronal views, right, displayed RV volume and shape.</p

Characteristics of the congenital heart defects examined by RT3DE.

*<p>information derived from RT3DE was unclear for diagnosis.</p>†<p>information derived from RT3DE was useful and obligatory for the diagnosis.</p

Ventricular SV, CO, CCO and EF by RT3DE in Normal and CHD Fetuses.

*<p>P<0.05, compared with CHD group. P>0.05, compared left ventricle with right ventricle in all indices.</p

RT3DE image analysis for LV volumes and mass based on 3 orthogonal planes.

<p>Upper left, 4-chamber view with easily identifiable morphological markers. Upper right,2-chamber view planes, Lower left, short-axis view of both ventricles, lower right, calculated LV volume and shape display.</p

RT3DE image quality scores.

<p>The 3D image quality was assessed as follows:</p><p>1′: <i>unacceptable</i>-image quality was not measurable;</p><p>2′: <i>poor</i>-image was judged as measurable but was suboptimal with artifacts;</p><p>3′: <i>acceptable</i>-image was clear, measurable and diagnostic;</p><p>4′: <i>good</i>-image was good, easily measurable and artifact was rarely present;</p><p>5′: <i>excellent</i>-image was extremely clear with all sharp borders for confident diagnosis and measurement.</p

Gestational growth and maturation of RV to LV SV ratio, LV and RV EFs, and CCO.

<p>Gestational growth and maturation of RV to LV SV ratio, LV and RV EFs, and CCO.</p

Gestational growth of LV and RV volumes in normal and CHD fetuses.

<p>Gestational growth of LV and RV volumes in normal and CHD fetuses.</p

Growth of LV and RV mass and stroke volume with gestational age in normal and CHD fetuses.

<p>Growth of LV and RV mass and stroke volume with gestational age in normal and CHD fetuses.</p

Mean Ventricular Volumes, Mass by RT3DE in Normal and CHD Fetuses.

*<p>P<0.05: compared with right ventricle; P>0.05: compared normal group with CHD group in all indices.</p><p>GA: gestational age, HR: heart rate.</p