Four-section approach of fetal congenital heart disease at 11–13+6 weeks

Figures

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  Figure 1. Four-section approach in early pregnancy. (A) Upper abdominal transverse section. (B–D) Two-dimensional, color Doppler, and tricuspid spectrum Doppler ultrasound of 4CV section. (E) 3VT section. (F) Bilateral subclavian artery section.

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  Figure 2. Flow chart of this cohort.

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  Figure 3. ROC curve comparison between different section approaches for diagnosis of CHD.

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  Figure 4. Abnormal image pattern of ultrasound in the upper abdominal transverse section. (A) Patterns of UAb-1: The stomach is on the right side of the abdomen, the superior vena cava is on the left front of the spine, and the abdominal aorta is on the right front of the spine. (B) Patterns of UAb-2: The stomach is small and located near the midline, while the superior vena cava is on the same side of the spine as the abdominal aorta. (C) Patterns of UAb-3: The stomach is small and located near the midline, and the dilated (hemiazygos vein) azygos vein is seen behind the right (left) of the descending aorta. (D) Patterns of UAb-4: The stomach is not seen on the transverse section of the upper abdomen.

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  Figure 5. Abnormal ultrasound image pattern of 4CV section. (A) Patterns of 4CV-1 showed that the heart is partially or completely located outside the chest cavity. (B) Patterns of 4CV-2 showed displacement of heart. (C) Patterns of 4CV-3: the cardiac axis is abnormally shifted to the forward. (D) Patterns of 4CV-4: The cardiac axis is abnormally shifted to the right. (E) Patterns of 4CV-5 indicate an increase in cardiothoracic ratio. (F) Patterns of 4CV-6, filling of both ventricles, but the left ventricle appears smaller. (G) Patterns of 4CV-7: The left heart is spherically enlarged, and the filling of left ventricle appears smaller. (H) Patterns of 4CV-8: The filling of the right heart increased obviously. (I) Patterns of 4CV-9, filling of both ventricles, but the right ventricle appears very smaller. (J) Patterns of 4CV-10, filling of only the right ventricle. (K) Patterns of 4CV-11, filling of only the left ventricle. (L) Patterns of 4CV-12 showed a central singular inflow. (M) Patterns of 4CV-13 indicate “Y”-shaped filling of the ventricular inflow tract during diastole. (N) Patterns of 4CV-14 indicate a ventricular septal defect. (O) Patterns of 4CV-15, mitral or tricuspid…

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  Figure 6. Abnormal ultrasound image pattern of 3VT section. (A) Patterns of 3VT-1, one vessel with a curved course or a straight course. (B) Patterns of 3VT-2: The aorta was smaller than the pulmonary artery. (C) Patterns of 3VT-3: The pulmonary artery was smaller than the aorta. (D) The aorta was smaller than the pulmonary artery, and reverse flow was observed in the aortic arch. (E) The “in–out sign” of the aorta and/or pulmonary artery. (F) Patterns of 3VT-6, two large arteries forming a “U” sign around the trachea. (G) Patterns of 3VT-7, two large arteries forming an “O” sign around the trachea. (G) Patterns of 3VT-8: The subclavian artery and aorta together form a “C” sign around the trachea. (H) Patterns of 3VT-8: The subclavian artery originates from the origin of the descending aorta and runs behind the trachea to form a “C”-type vascular ring.

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  Figure 7. Abnormal ultrasound image pattern of the bilateral subclavian artery section. (A) Normal bilateral subclavian arteries are in front of the trachea, and they form a “bow” structure. (B) BSa-1 pattern: The right subclavian artery originates from the descending aorta, bypasses the trachea, and then runs to the right. (C) BSa-2 pattern shows that the left subclavian artery originates from the descending aorta and is circumvented behind the trachea to the left.