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Frühe fetale Echokardiographie

Early fetal echocardiography

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Zusammenfassung

Die frühe fetale Echokardiographie erfordert besondere Kenntnisse der fetalen Herzanatomie, der technischen Limitationen und im Bereich der Transvaginalsonographie. Kongenitale Herzfehler gehören zu den häufigsten angeborenen schweren Fehlbildungen. Die klassischen Indikationen zur fetalen Echokardiographie werden in der frühen Schwangerschaft durch den Nachweis einer verdickten Nackentransparenz ergänzt. Eine verdickte Nackentransparenz ist mit einem höheren Risiko für Herzdefekte assoziiert. Allerdings weisen nur 10–20% der schwereren Herzfehler eine verdickte Nackentransparenz auf, sodass die Entdeckungsraten für Herzfehler weit niedriger liegen als bei der detaillierten Darstellung des Vierkammerblicks im 2. Trimenon und der Kombination von Vierkammerblick- und Ausflusstraktdarstellung im 2. Trimenon. Doppleruntersuchungen des Ductus venosus zwischen der 11. und 14. SSW könnten zusätzlich hilfreich sein. Da strukturelle Anomalien des fetalen Herzens und der großen Gefäße sich erst später im Verlauf der Schwangerschaft manifestieren können, ist auch bei Darstellung einer normalen kardialen Anatomie und normaler Blutflussmuster im Rahmen der frühen Echokardiographie eine weitere Echokardiographie um die 20. SSW erforderlich.

Abstract

The development of high-resolution ultrasound machines with high-frequency transvaginal and transabdominal probes as well as use of color Doppler echocardiography have made it possible to evaluate fetal heart status in detail as early as the end of the first trimester and beginning of the second trimester of pregnancy. Early fetal echocardiography not only requires extensive knowledge of early fetal cardiac anatomy and awareness of technical limitations, but also expertise in the field of transvaginal sonography. These prerequisites are usually only met in specialized centers so that its use is limited to groups at risk of congenital heart abnormalities. The prevalence of congenital heart defects is 5–8 per 1000 live births, making them the most frequent of severe congenital malformations. Because of the high lethality in fetuses with severe deformities, especially chromosomal aberrations and cardiac defects, prevalence during the first trimester is likely to be 15–20 per 1000 fetuses. The classic indications for fetal echocardiography are supplemented by evidence of increased nuchal translucency in early pregnancy since measurement of nuchal translucency between the 11th and 14th week of gestation serves to identify fetuses not only at increased risk of chromosomal anomalies but also of congenital heart defects. The prevalence of defects increases in tandem with nuchal thickness. Increased nuchal translucency thickness is associated with a higher risk of heart defects than many other established indications for echocardiography. Admittedly, however, only 10–20% of severe cardiac defects exhibit increased nuchal translucency during early pregnancy so that the detection rates for cardiac defects are much lower than with a detailed four-chamber view on imaging during the second trimester (40%) and the combination of four-chamber view and imaging of the outflow tract in the second trimester (70%). Doppler examination of the ductus venosus between the 11th and 14th week of gestation can provide additional information since an association between abnormal blood flow patterns in the ductus venosus and cardiac defects in fetuses with increased nuchal translucency and normal karyotype has been described. Since structural anomalies of the fetal heart and the large vessels only become manifest in the later course of pregnancy, even when imaging evidences normal cardiac anatomy and normal blood flow pattern, a further echocardiographic examination is necessary around the 20th week of gestation, as is the case in all indications for echocardiography.

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  1. Bereich für Pränatale Medizin, Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck

    J. Smrcek, M. Krapp & R. Axt-Fliedner

  2. Klinik für Geburtshilfe und Pränatale Medizin, Zentrum für Geburtshilfe und Gynäkologie, Universitätsklinikum Bonn

    U. Gembruch

  3. Bereich für Pränatale Medizin, Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 , Lübeck

    J. Smrcek

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  1. J. Smrcek
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Smrcek, J., Krapp, M., Axt-Fliedner, R. et al. Frühe fetale Echokardiographie. Gynäkologe 37, 716–724 (2004). https://doi.org/10.1007/s00129-004-1568-x

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