Fetal CMR detects congenital heart defects and changes treatment decisions

When echocardiography results are unclear, fetal cardiovascular MRI (CMR) can provide valuable information about congenital heart defects, leading to changes in treatment or management decisions in more than 80% of cases, reports a new study.

Not only could this imaging information be used to augment treatment for infants, a team from Lund University in Sweden said, but it could also be useful in providing advice to parents. In fact, they said, 84 percent of cases referred for fetal RMC captured clinically valuable data that impacted delivery mode choices, early postnatal care planning and parental counseling.

“In this study, fetal CMR added clinically useful information to echocardiography in referred cases and was a useful adjunct to fetal echocardiography to assess cardiac function and intracardiac and vascular anatomy in [congenital heart defects]Said the team led by Daniel Salehi, MD, a doctoral candidate in clinical physiology at Lund University.

The team published their findings in JAMA network open.

Congenital heart defects (CHD) are rare and only occur in 1% of children. However, they are responsible for about 30 percent of infant deaths from birth defects, and 25 percent of all cases involve complex defects that require intervention in the first year of life.

Echocardiography usually detects coronary heart disease in utero, but if the acoustic window is inadequate, the results of the analysis will be inconclusive. An MRI-enabled Doppler ultrasound machine can work around this problem to capture high-resolution fetal CMR images without the need for post-processing, the team said.

Related Content: 4D MRI: A “Huge Leap Forward” in Fetal Cardiac MRI Imaging

To determine how well fetal RMC performed following inconclusive echocardiography studies – and whether new information guided parenting decisions – Salehi’s team looked at the results of 31 fetuses, with gestational age average of 36 weeks, who were referred for fetal RMC to Skåne University Hospital between January 2017 and June 2020.

In addition to contributing to decision-making and parental counseling in 84% of cases, the team also determined that fetal CMR also provided useful information in other cases:

  • Intracardiac anatomy and ventricular function were visualized in 87% of fetuses to assess univentricular results versus biventricular results in the borderline left ventricle, unbalanced interatrial communication, and pulmonary atresia with intact ventricular septum.
  • Diagnostic information was added in 80% of the aortic arch anatomy cases, including signs of coarctation.
  • A birth planning assistant was provided for 75% of fetuses with hypoplastic left heart syndrome.
  • Valuable information for parenting counseling was offered in 68 percent of cases.

“These results suggest that fetal cardiovascular magnetic resonance imaging may add important diagnostic information and affect clinical decision making and parental counseling,” the team said.

But, even with these benefits with fetal CMR, there is still a role for echocardiography, said Bhawna Arya, MD, attending physician and assistant professor of pediatrics at Seattle Children’s Hospital in an accompaniment. editorial. Fetal echocardiography is useful for identifying coronary heart disease as early as week 12 of gestation – fetal CMR is relegated to later gestation and larger fetal height, she said.

“Although fetal CMR offers an attractive opportunity for advanced and late gestational imaging, fetal echocardiography remains the gold standard for the early and accurate in utero diagnosis and monitoring of congenital heart disease and other diseases. fetal cardiovascular disease, ”she said.

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