SCREENING IN PREGNANCY FOR CONGENITAL HEA RT-DISEASE BY 4-CHAMBER VIEW AND VISUALIZATION OF THE GREAT-VESSELS - ACCURACY AND LIMITATIONS

The four-chamber view and the visualization of the root of the left an d right ventricular outflow tracts has been proposed as a screening me thod for the detection of congenital heart disease in the fetus. In or der to study the diagnostical value of the method we investigated 1600 fetuses between the 17th and 40th gestational week without anamnestic risk for congenital heart disease with this screening method in a two years' period. We found 33 fetuses to have an abnormality either in t he four-chamber view or in the ventricular outflow tracts. The sensiti vity of the method in the detection of congenital heart disease was fo und to be 81%, the specificity 99% and the positive predictive value 8 8%. Women at high risk for congenital heart disease in the fetus shoul d still undergo a more detailed echocardiographic examination to maxim ize the sensitivity in the detection of structural heart defects. Neve rtheless, the described screening procedure is an effective and feasib le method to detect fetuses with severe congenital heart disease, whos e prognosis may be improved by the delivery in a perinatological cente r.