Detailed three-dimensional fetal echocardiography facilitated by an Internet link

Objectives To assess whether a complete virtual cardiological examination c an be achieved in stored three-dimensional volumes of the fetal heart, tran smitted to a tertiary fetal cardiology center via the Internet. Methods Thirty sequential normal singleton pregnancies were included in the study. Four cardiac volumes were acquired using a three-dimensional ultras ound system. The volumes were sent via the Internet to a tertiary fetal car diology center, where a detailed fetal cardiac examination was attempted us ing the three-dimensional volumetric dataset. Results The median gestational age was 24 (range, 22-28) weeks. A complete heart examination was accomplished in 23 of 30 cases (76.7%; 95% confidence interval, 58-90%). The four-chamber view and the cardiac situs were seen i n all cases. The right ventricular outflow tract was seen in 29 (96.7%) cas es and the left ventricular outflow tract in 25 (83.3 %) cases. The long-ax is view of the aortic arch, superior vena cava, inferior vena cava and pulm onary veins were visualized in more than 80% of cases. The mean time of vol ume acquisition was 9.5 (standard deviation, 2.3) min and the mean examinat ion time by the fetal cardiologist was 17 (standard deviation, 4.8) min. Conclusions These preliminary results demonstrate that a three-dimensional virtual examination of the fetal heart is possible. There are limitations s uch as the lack of flow and functional information but complete ascertainme nt of the main cardiac connections was possible in the majority of cases. T he use of an Internet link has major implications, particularly for situati ons in which the scanning center is geographically remote from the tertiary referral center.