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Background: Prenatal echocardiographic assessment of fetal cardiac function has become increasingly important. Fetal two‐dimensional speckle‐tracking echocardiography (2D‐STE) allows the determination of global and segmental functional cardiac parameters. Prenatal diagnostics is relying increasingly on artificial intelligence, whose algorithms transform the way clinicians use ultrasound in their daily workflow. The purpose of this study was to demonstrate the feasibility of whether less experienced operators can handle and might benefit from an automated tool of 2D‐STE in the clinical routine. Methods: A total of 136 unselected, normal, singleton, second‐ and third‐trimester fetuses with normofrequent heart rates were examined by targeted ultrasound. 2D‐STE was performed separately by beginner and expert semiautomatically using a GE Voluson E10 (FetalHQ®, GE Healthcare, Chicago, IL). Several fetal cardiac parameters were calculated (end‐diastolic diameter [ED], sphericity index [SI], global longitudinal strain [EndoGLS], fractional shortening [FS]) and assigned to gestational age (GA). Bland‐Altman plots were used to test agreement between both operators. Results: The mean maternal age was 33 years, and the mean maternal body mass index prior to pregnancy was 24.78 kg/m2. The GA ranged from 16.4 to 32.0 weeks (average 22.9 weeks). Averaged endoGLS value of the beginner was ‐18.57% ± 6.59 percentage points (pp) for the right and ‐19.58% ± 5.63 pp for the left ventricle, that of the expert ‐14.33% ± 4.88 pp and ‐16.37% ± 5.42 pp. With increasing GA, right ventricular endoGLS decreased slightly while the left ventricular was almost constant. The statistical analysis for endoGLS showed a Bland‐Altman‐Bias of ‐4.24 pp ± 8.06 pp for the right and ‐3.21 pp ± 7.11 pp for the left ventricle. The Bland‐Altman‐Bias of the ED in both ventricles in all analyzed segments ranged from ‐.49 mm ± 1.54 mm to ‐.10 mm ± 1.28 mm, that for FS from ‐.33 pp ± 11.82 pp to 3.91 pp ± 15.56 pp and that for SI from ‐.38 ±.68 to ‐.15 ±.45. Conclusions: Between both operators, our data indicated that 2D‐STE analysis showed excellent agreement for cardiac morphometry parameters (ED and SI), and good agreement for cardiac function parameters (EndoGLS and FS). Due to its complexity, the application of fetal 2D‐STE remains the domain of scientific‐academic perinatal ultrasound and should be placed preferably in the hands of skilled operators. At present, from our perspective, an implementation into clinical practice "on‐the‐fly" cannot be recommended. [ABSTRACT FROM AUTHOR]

Diastolic dysfunction (DD) is a prevalent and clinically significant complication after heart transplantation (HTX). We aimed to characterize the diastolic function of HTX recipients with both short-term and long-term follow-ups by applying left atrial (LA) deformation analysis. We consecutively enrolled and followed up with 33 HTX patients. Three assessments were performed one month, 3–5 months, and 3–5 years after surgery. Beyond conventional echocardiographic measurements, apical four-chamber views optimized for speckle tracking analysis were acquired and post-processed by dedicated software solutions (TomTec AutoStrain LA and LV). Left atrial phasic functions were characterized by reservoir, conduit, and contraction strains. We categorized diastolic function according to current guidelines (normal diastolic function, indeterminate, DD). At the first assessment, nine (27%) patients were in the DD category, and eleven (33%) were indeterminate. At the second assessment, only one patient (3%) remained in the DD category and six (18%) were indeterminate. At the third assessment, 100% of patients were categorized as having normal diastolic function. LA reservoir strain gradually increased over time. LA contraction strain significantly improved from the second to the third assessment. We found a correlation between the LA reservoir strain and NT-proBNP (r = 0.40, p < 0.05). DD is prevalent immediately after HTX but rare until the end of the first postoperative quarter. Speckle tracking analysis enables the characterization of LA phasic functions that may reflect both short- and long-term changes in diastolic function and correlate with NT-proBNP. [ABSTRACT FROM AUTHOR]

Cardiopulmonary and infectious complications are more common in preterm newborns after preterm premature rupture of membranes (pPROM). Fetal echocardiography may be helpful in predicting neonatal condition. Our aim was to assess the cardiovascular changes in fetuses from pregnancies complicated by pPROM and possible utility in predicting the intrauterine or neonatal infection, and neonatal heart failure (HF). It was a prospective study enrolling 46 women with singleton pregnancies complicated by pPROM between 18+0 and 33+6 weeks of gestation and followed until delivery. 46 women with uncomplicated pregnancies served as a control group. Fetal echocardiographic examinations with the assessment of cardiac structure and function (including pulmonary circulation) were performed in all patients. Mean gestational age of pPROM patients was 26 weeks. Parameters suggesting impaired cardiac function in fetuses from pPROM were: higher right ventricle Tei index (0.48 vs. 0.42 p<0.001), lower blood flow velocity in Ao z-score (0.14 vs. 0.84 p=0.005), lower cardiovascular profile score (CVPS), higher rate of tricuspid regurgitation (18.2 % vs. 4.4 % p=0.04) and pericardial effusion (32.6 vs. 0 %). Intrauterine infection was diagnosed in 18 patients (39 %). 4 (8.7 %) newborns met the criteria of early onset sepsis (EOS). HF was diagnosed in 9 newborns. In fetal echocardiographic examination HF group had shorter mitral valve inflow time and higher left ventricle Tei index (0.58 vs. 0.49 p=0.007). Worse cardiac function was observed in fetuses from pPROM compared to fetuses from uncomplicated pregnancies. [ABSTRACT FROM AUTHOR]

Introduction: Crossed pulmonary arteries (CPA) is an abnormality in which the ostium of the left pulmonary artery is located rightward and the ostium of the right pulmonary artery is leftward. Case report: We diagnosed a fetus with CPA prenatally. In fetal echocardiography, left pulmonary artery was seen to pass beneath the ductus and directing toward the left side and pulmonary artery bifurcation could not be demonstrated at the same plane. Postnatal echocardiography reconfirmed the presence of CPA. Bilateral choanal atresia, genital hypoplasia, hearing loss with facial and external ear asymmetry and psychomotor delay of the newborn led to clinical diagnosis of CHARGE syndrome and was confirmed by gene analysis. Discussion/Conclusion: CPA may be one of the cardiac anomalies in CHARGE syndrome. [ABSTRACT FROM AUTHOR]

Background: Fetal two-dimensional speckle tracking echocardiography (2D-STE) is an emerging technique for assessing fetal cardiac function by measuring global longitudinal strain. Alterations in global longitudinal strain may serve as early indicator of pregnancy complications, making 2D-STE a potentially valuable tool for early detection. Early detection can facilitate timely interventions to reduce fetal and maternal morbidity and mortality. Therefore, the aim of this study was to investigate the feasibility of performing 2D-STE at 16 weeks gestational age. Methods: This pilot study utilized 50 ultrasound clips of the fetal four-chamber view recorded between 15+5 and 16+2 weeks gestational age from a prospective cohort study. A strict protocol assessed three parameters essential for 2D-STE analysis: fetal four-chamber view ultrasound clip quality, region of interest, and frame rates. Two independent researchers measured global longitudinal strain in all adequate fetal four-chamber view ultrasound clips to determine inter- and intra-operator reliability. Results: Out of the 50 ultrasound clips, 37 (74%) were feasible for 2D-STE analysis. The inter-operator reliability for global longitudinal strain measurements of the left and right ventricles was moderate (ICC of 0.64 and 0.74, respectively), while the intra-operator reliability was good (ICC of 0.76 and 0.79, respectively). Conclusions: Our findings demonstrate that fetal 2D-STE analysis at 16 weeks gestational age is feasible when adhering to a strict protocol. However, further improvements are necessary to enhance the inter- and intra-operator reliability of 2D-STE at this gestational age. [ABSTRACT FROM AUTHOR]

Aims: The study aims to evaluate the genetic and clinical outcomes of fetal cardiac rhabdomyoma in our tertiary center. Methods: Data of cases with cardiac rhabdomyoma detected by fetal echocardiography during antenatal follow‐up were analyzed retrospectively. Results: Nine cases were included in the study. The incidence of cardiac rhabdomyoma was 0.003%. The median fetal diagnosis time was 26th weeks, the most common location was the LV. There was no hemodynamic disorder requiring cardiovascular intervention in any of the cases. Of the eight genetically tested cases, four were tuberous sclerosis complex (TSC) gene‐negative, one hereditary TSC2, one de novo TSC1, and two de novo TSC2 gene mutants. Postnatal first‐year survival rate of the cases was 88.8%. Conclusions: Cardiac rhabdomyoma is a rare fetal and pediatric pathology that generally is a remarkable finding in the clinical process of TSC. Therefore, cases should be evaluated multisystemically and genetic counseling should be given to the family. [ABSTRACT FROM AUTHOR]

To evaluate the changes of cardiac morphology and function in fetuses conceived through assisted reproductive technologies (ART) by speckle tracking echocardiography. A retrospective study was conducted in 101 spontaneously conceived (SC) fetuses and 99 ART-conceived ones. Fetal echocardiography was performed, fetal cardiac morphology and function were analyzed using two-dimensional speckle tracking software, including global sphericity index (GSI), global longitudinal strain (GLS), fractional area change (FAC) of the left and right ventricles, as well as segmental sphericity index (SI), end-diastolic diameter (ED), and fractional shortening (FS) in 24 segments. Compared to the SC fetuses, the ART-conceived fetuses exhibited decreased GSI (median [interquartile range], 1.22 [1.16–1.27] vs. 1.18 [1.11–1.24], p=0.007), decreased right ventricular GLS (24.9 [21.5–27.6] vs. 23.2 [20.4–26.8], p=0.026), and decreased right ventricular FAC (mean ± standard deviation, 39.7 ± 6.4 vs. 37.2 ± 7.1, p=0.003). Analysis of the 24 segments showed that ART-conceived fetuses had reduced SI in the apical segments of right ventricle and increased ED in several segments of the right ventricle. Fetuses conceived through ART had a more spherical shape of the global heart and predominantly right-sided cardiac remodeling and systolic function impairment. [ABSTRACT FROM AUTHOR]

Background: Hyperglycemia during pregnancy can affect fetal heart in many ways, including causing cardiac malformation, leading to hypertrophic cardiomyopathy and cardiac dysfunction. Echocardiographic evaluation can assist identify alterations in heart structure, morphology and function, enabling prompt monitoring and management. However, according to earlier research, the cardiac alterations are modest in hyperglycemic mothers' fetuses, and might not be detectable using conventional methods and it is also unclear whether these changes are related to the metabolism of mothers. Fetal Heart Quantification (Fetal HQ) can assess ventricular geometry and function more sensitively and thoroughly, and identify sub-clinical cardiac dysfunction. The purpose of this study was to evaluate fetal heart by Fetal HQ in fetuses of hyperglycemic mothers who either had pre-gestational or gestational diabetes and to correlate them with maternal metabolic indices. Methods: The fetuses of 25 gestational age-matched control mothers, 48 women with gestational diabetes mellitus (GDM), and 11 women with diabetes mellitus (DM) were included in the prospective case-control research. Using fetal echocardiography and speckle tracking echocardiography (STE), the heart of the fetus was evaluated. Differences in the groups' anthropometric, metabolic, and cardiac parameters were examined. It was assessed whether maternal features, prenatal glucose, lipids, and maternal hemoglobin A1c (HbA1c) correlated with fetal cardiac parameters. Results: The LV EDV and ESV were significantly higher in the GDM group as compared to the DM group (p < 0.05). The GSI% was significantly lower in the GDM group compared with the control (p < 0.05). The LV SV and CO of the GDM group were both significantly higher compared with the DM group (p < 0.05). There was a significant decrease in RV FS for segments 1–7 in GDM fetuses compared to the control (p < 0.05) and for segments 5–10 compared to DM (p < 0.05). Fetal cardiac morphology and function indices correlate with maternal pregestational weight, BMI, early pregnancy fast glucose, lipids, and glycemic control levels. Conclusions: Fetuses exposed to gestational diabetes have altered heart morphology and function that is linked to maternal metabolic parameters, which presents a special indication for performing geometry and function cardiac assessment. Fetal HQ can be employed to evaluate the fetal cardiac shape and function in fetuses exposed to gestational diabetes. [ABSTRACT FROM AUTHOR]

Congenital ventricular aneurysm is a very rare cardiac anomaly. A diagnosis can be made during the prenatal period using fetal echocardiography. This study presents a very rare apically located left ventricular aneurysm case, and the relevant literature was reviewed and discussed. In this case, a 35-year-old, gravida 2, parity 1 pregnant woman at 24 weeks of gestation, displayed a wide aneurysmal image in the left ventricular apical wall on fetal echocardiography. There was a 1.79 mm muscular ventricular septal defect at the apical region of the interventricular septum. In the course of the color Doppler ultrasonography examination, an aberrant fibrous band within the left ventricle and consequent turbulent flow during systole were observed. The baby, born via cesarean section at 37 weeks of gestation, is now in its postnatal seventh month. However, during echocardiographic follow-ups, changes have been observed, including mild to moderate mitral insufficiency and a decrease in systolic function. Despite these findings, the clinical condition remains asymptomatic. It is of great importance to use a multidisciplinary approach in managing these rare cases that could lead to potential adverse outcomes during the antenatal or postnatal periods. [ABSTRACT FROM AUTHOR]

Aim: Down syndrome is the most common well-known chromosomal disorder. The incidence of congenital heart disease (CHD) in these patients is high and it is the most important cause of mortality. In this study, we reviewed the comorbid CHDs and their characteristics in patients with the diagnosis of Down syndrome. We compared our results with the results of studies conducted in different regions of our country in different years. Materials and Methods: Between January 2020 and December 2022, data from a total of 385 patients (175 females, 210 males) with Down syndrome were evaluated. The age of the mothers at the time of delivery and the availability of prenatal diagnosis information in accessible patients were determined. Results: Of 385 patients with Down syndrome, 38.2% (n=147) had CHD. Among patients with CHD, 57 patients had atrioventricular septal defect (AVSD)(38.7%), 35 patients had perimembranous ventricular septal defect (23.8%), 24 patients had secundum atrial septal defect(16.3%), 8 patients had patent ductus arteriosus(5.4%), and 10 patients without AVSD had CHD with multiple left-to-right shunts (6.8%). The most common cyanotic CHD was tetralogy of Fallot (n=7, 4.7%). Complete AVSD was present in 63.1% of AVSD patients. CHD was present in 36.2% of boys and 40.6% of girls. Among all female patients, 17.1% had AVSD, while this rate was 12.8% among all male patients (p<0.05). The mean maternal age at delivery was 32.59±6.9 (17-48) years. It was found that children with Down syndrome whose mothers had a maternal age of 33.5 years and above had a lower rate of CHD. Of the 170 mothers for whom prenatal diagnosis information was available, 58.2% (n=99) had a prenatal diagnosis. Conclusion: Prenatal diagnosis opportunities have increased and become widespread over the years. However, no significant change was observed in the rates of CHD, which is most frequently responsible for mortality in children with Down syndrome. It is appropriate for every expectant mother with a prenatal diagnosis to be referred for fetal echocardiography or postnatal transthoracic echocardiography. [ABSTRACT FROM AUTHOR]

Objective: To assess the accuracy of prenatal echocardiography in defining pulmonary vasculature in pulmonary atresia with VSD (PAVSD). The second aim is to compare the perinatal and postnatal outcomes of different pulmonary blood supply types. Study design: The cases prenatally diagnosed with PAVSD between 2017 and 2022 in a single tertiary fetal medicine center were identified on the electronic database. Fetal echocardiography reports and images were reviewed retrospectively. Postnatal outcomes were acquired from the hospital records of relevant pediatric cardiology and cardiovascular surgery clinics. Fetal echocardiography results were compared with postnatal results. Perinatal and postnatal outcomes were compared between the different pulmonary vascular supply types. Results: Among the 24 PAVSD cases, six were diagnosed with major aortopulmonary collateral arteries (MAPCA) dependent, eleven were diagnosed with ductus arteriosus (DA) dependent pulmonary supply, and seven were diagnosed with double pulmonary supply (MAPCA + DA) on prenatal echocardiography. Seventeen cases were live‐born and have undergone postnatal investigations. Fetal echocardiography was 88.2% accurate about the type of pulmonary supply. The accuracy of fetal echocardiography regarding pulmonary vascular anatomy was 82.3%. Postoperative survival was 69.2%. Mortality before surgery and postoperative survival did not differ between pulmonary supply groups. Survival was impaired by the extracardiac anomalies. The need for early interventions was significantly higher in the DA group. Conclusion: Pulmonary vascularization in PAVSD can be defined precisely on fetal echocardiography. The source of pulmonary blood supply does not impact postnatal short‐term outcomes significantly but it impacts the management. The associated anomalies highly contribute to postnatal mortality. [ABSTRACT FROM AUTHOR]

Objective: To note the factors linked with delayed diagnosis of congenital heart diseases (CHDs) among children. Study Design: Cross-sectional study. Setting: Department of Pediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan. Period: September 2022 to February 2023. Material & Methods: We analyzed children aged up to 15 years who presented for the first time with echocardiographic evidence for the diagnosis of CHDs. Socio-demographic data along with clinical information like gender, age, residential status, maternal education status, history of maternal fetal echocardiography and the frequency of delayed diagnosis of CHDs were noted on a specially made proforma. Parent or guardians were asked for possible reasons of delayed diagnosis for CHDs. Results: In a total of 250 children, the mean age was 2.33±3.81 years while 162 (64.8%) children were aged below 2 years. There were 138 (55.2%) boys. Residential status of 159 (63.6%) children was rural while maternal educational status of 99 (39.6%) was illiterate. There were 164 (65.6%) children who were diagnosed to have cyanotic CHDs while 86 (34.4%) had acyanotic CHDs. Frequency of delayed diagnosis was noted among 182 (72.8%) children. In these 182 cases, delayed first consultation was the commonest factor behind delayed diagnosis noted in 78 (42.9%) children while missed diagnosis by the pediatrician was the 2nd most common factors linked with the delayed diagnosis of CHDs as described by 62 (34.1%) parents. Conclusion: Almost 3/4th of the studied children had delayed diagnosis of CHDs while cyanotic CHDs were the most common CHD types. Delayed first consultant and missed diagnosis by the pediatrician were the most common factors linked with delayed diagnosis of CHDs. [ABSTRACT FROM AUTHOR]

Truncus arteriosus (TA) is a rare congenital heart defect that can be prenatally detected by fetal echocardiography. However, prognostication and prenatal counseling focus primarily on surgical outcomes due to limited fetal and neonatal pre-surgical mortality data. We aimed to describe the incidence and identify predictors of pre-surgical mortality in prenatally detected TA. This two-center, retrospective cohort study included fetuses diagnosed with TA between 01/2010 and 04/2020. The primary outcome was pre-surgical mortality, defined by fetal or neonatal pre-surgical death or primary listing for transplantation prior to discharge. Univariable regression modeling, Chi-square tests, and t tests assessed for associations between prenatal clinical, demographic, and fetal echocardiographic (fetal-echo) variables and pre-surgical mortality. Of 23 pregnancies with prenatal diagnosis of TA, 4 (17%) were terminated. Of the remaining 19, pre-surgical mortality occurred in 4 (26%), including 2 (11%) fetal deaths and 2 (11%) neonatal pre-surgical deaths. No transplantation listings. Of liveborn fetuses (n = 17), 15 (88%) underwent a neonatal surgery, and 1 (6%) required ECMO. As compared to the survivors, the pre-surgical mortality group had a higher likelihood of having left ventricular dysfunction (0% vs. 40%; p = 0.01), right ventricular dysfunction (0% vs. 60%; p = 0.002), cardiovascular profile score < 7 (0% vs. 40%; p = 0.01), skin edema (0% vs. 40%; p = 0.01), and abnormal umbilical venous (UV) Doppler (0% vs. 60%; p = 0.002). The presence of truncal valve regurgitation or stenosis neared significance. In this cohort with prenatally diagnosed TA, there is significant pre-surgical mortality, including fetal death and neonatal pre-surgical death. Termination rate is also high. Fetal-echo variables associated with pre-surgical mortality in this cohort include ventricular dysfunction, low CVP, skin edema, and abnormal UV Doppler. Knowledge about prenatal risk factors for pre-surgical mortality may guide parental counseling and postnatal planning in prenatally diagnosed TA. [ABSTRACT FROM AUTHOR]

Objective Heterotaxy syndrome (HS) is often associated with complex congenital heart disease (CHD). While fetal echocardiography (FE) permits accurate prenatal identification of most CHD, the high level of disease complexity in HS may pose challenges in predicting postnatal findings and outcomes. This study aimed to define the accuracy of FE in predicting postnatal anatomy, physiology, and surgical management of CHD in the setting of HS. Study Design Retrospective single-center cohort study including all patients with a prenatal diagnosis of HS from 2003 to 2018. Anatomic diagnoses from FE reports were compared with postnatal echocardiogram, catheterization, and operative reports. Prenatal predictions were compared with postnatal outcomes with a focus on ductal dependence, time to first intervention (immediate, neonatal period, 1–6 months, or older than 6 months), and surgical approach (single or biventricular). Results There were 102 pregnancies with fetal HS resulting in 21 terminations, 5 fetal losses, and 76 live births. Of the live births, 55 had significant CHD and available postnatal data for review. Among this group, survival to 1 year was 62% and was no different comparing single versus biventricular surgical approach. FE diagnostic accuracy varied by anatomic feature and was the lowest for diagnosis of venous anatomy. Determination of postnatal care was most accurate for predicting single versus biventricular surgical approach (91%), followed by ductal dependence (75%). Accuracy for predicting time to first intervention was the lowest at 69%. The most common reason for an incorrect prediction was difficulty in assessing the severity of pulmonary stenosis. Conclusion FE permits accurate predictions regarding surgical approach. Characterizing systemic and pulmonary veins is challenging, as is predicting ductal dependence and time to first intervention. These data suggest that despite the high diagnostic accuracy of CHD in HS, a circumspect approach may be reasonable with regard to predicting some anatomic details and postnatal management decisions. Key Points In HS, FE was most accurate for intracardiac anatomy. Diagnostic accuracy of venous anatomy was less reliable. Predicting surgical approach (single ventricle vs. biventricular) was highly accurate. Predicting ductal dependence and time-to-intervention were more challenging in some instances. [ABSTRACT FROM AUTHOR]

Background: Congenital Heart Disease represents the most frequent fetal malformation. The lack of prenatal identification of congenital heart defects can have adverse consequences for the neonate, while a correct prenatal diagnosis of specific cardiac anomalies improves neonatal care neurologic and surgery outcomes. Sonographers perform prenatal diagnosis manually during the first or second-trimester scan, but the reported detection rates are low. This project's primary objective is to develop an Intelligent Decision Support System that uses two-dimensional video files of cardiac sweeps obtained during the standard first-trimester fetal echocardiography (FE) to signal the presence/absence of previously learned key features. Methods: The cross-sectional study will be divided into a training part of the machine learning approaches and the testing phase on previously unseen frames and eventually on actual video scans. Pregnant women in their 12–13 + 6 weeks of gestation admitted for routine first-trimester anomaly scan will be consecutively included in a two-year study, depending on the availability of the experienced sonographers in early fetal cardiac imaging involved in this research. The Data Science / IT department (DSIT) will process the key planes identified by the sonographers in the two- dimensional heart cine loop sweeps: four-chamber view, left and right ventricular outflow tracts, three vessels, and trachea view. The frames will be grouped into the classes representing the plane views, and then different state-of-the- art deep-learning (DL) pre-trained algorithms will be tested on the data set. The sonographers will validate all the intermediary findings at the frame level and the meaningfulness of the video labeling. Discussion: FE is feasible and efficient during the first trimester. Still, the continuous training process is impaired by the lack of specialists or their limited availability. Therefore, in our study design, the sonographer benefits from a second opinion provided by the developed software, which may be very helpful, especially if a more experienced colleague is unavailable. In addition, the software may be implemented on the ultrasound device so that the process could take place during the live examination. Trial registration: The study is registered under the name „Learning deep architectures for the Interpretation of Fetal Echocardiography (LIFE)", project number 408PED/2020, project code PN-III-P2–2.1-PED-2019. Trial registration: ClinicalTrials.gov, unique identifying number NCT05090306, date of registration 30.10.2020. [ABSTRACT FROM AUTHOR]

Background: The value of prenatal identification of morphology of ductus arteriosus in fetuses with congenital heart defects (CHD) with pulmonary atresia and duct-dependent pulmonary circulation (DDPC) in planning neonatal ductal stenting procedure is untested. The aim of the study is to analyze the utility of three-dimensional/four-dimensional (3D/4D) spatiotemporal image correlation (STIC) fetal echocardiography in delineating the morphology of ductus arteriosus in fetuses with DDPC undergoing neonatal ductal stenting. Methods: In this retrospective study (2017-22), prenatal imaging of pulmonary artery (PA) anatomy, aortic arch sidedness, and morphology of ductus arteriosus (ductal origin was classified as vertical/horizontal and ductal course as tortuous/straight) was done using 3D/4D STIC imaging and volume datasets. Prenatal findings were correlated with angiographic findings during stenting and the degree of agreement was calculated. Results: We included 27 fetuses with a prenatal diagnosis of CHD with DDPC who underwent neonatal ductal stenting. The accuracy of prenatal assessment of PA anatomy, branch PA stenosis, and arch sidedness was 100%, 92.6%, and 88.9%, respectively. The accuracy of prenatal assessment of ductal origin and course, compared with angiography, was 85.2% and 88.9%, respectively. Prenatal imaging had a diagnostic accuracy of 100% for vertical straight and horizontal tortuous ducts, 84.6% for vertical tortuous, and 67% for horizontal straight ducts. Duct stenting was successful in 25 (92.6%) babies; two died after the procedure from stent occlusion. Conclusion: Fetal echocardiography using 3D/4D STIC imaging enables accurate delineation of the morphology of ductus arteriosus in fetuses with DDPC, thereby aiding parental counseling and planning neonatal ductal stenting. [ABSTRACT FROM AUTHOR]

Background: Abnormalities of the fetal cardiovascular system caused by fetal growth restriction (FGR) may lead to adverse outcomes. The fetal cardiac function assessment is of great significance for treatment selection and prognostic evaluation of fetuses with FGR. Objective: This study aimed to explore the value of fetal HQ analysis based on speckle tracking imaging (STI) to evaluate the global and regional cardiac function of fetuses with early‐onset or late‐onset FGR. Methods: From June 2020 to November 2022, 30 pregnant women with early‐onset FGR (21–38 gestational weeks) and 30 pregnant women with late‐onset FGR (21–38 gestational weeks) in the Department of Ultrasound, Shandong Maternal and Child Health Hospital were enrolled. Also, 60 healthy volunteer pregnant women were enrolled as two control groups according to the principle of matching gestational weeks (21–38 gestational weeks). The fetal cardiac functions, including fetal cardiac global spherical index (GSI), left ventricular ejection fraction (LVEF), fractional area change (FAC) of both ventricles, global longitudinal strain (GLS) of both ventricles, 24‐segmental fractional shortening (FS), 24‐segmental end‐diastolic ventricular diameter (EDD), and 24‐segmental spherical index (SI), were assessed using fetal HQ. The standard biological values of fetuses and Doppler blood flow parameters of fetuses and mothers were measured. The estimated fetal weight (EFW) measured by the last prenatal ultrasound was calculated, and the weights of newborns were followed up. Results: Among early FGR, late FGR and total control group, significant differences were found in global cardiac indexes of right ventricle (RV), left ventricle (LV) and GSI. For the segmental cardiac indexes, there are significant differences in three groups except parameter of LVSI. Compared with the control group at the same gestational week, the Doppler indexes including MCAPI and CPR in both the early‐onset FGR group and the late‐onset FGR group were significantly different. The intra‐ and inter‐observer correlation coefficients of RV FAC, LV FAC, RV GLS, and LV GLS were good. Further, the intra‐ and inter‐observer variability in FAC and GLS was small, as analyzed using the Bland–Altman scatter plot. Conclusions: Fetal HQ software based on STI showed that FGR affected the global and segmental cardiac function of both ventricles. FGR no matter early‐onset or late‐onset altered Doppler indexes significantly. The FAC and the GLS had satisfactory repeatability in evaluating fetal cardiac function. [ABSTRACT FROM AUTHOR]

Objective: In fetuses with suspicion of congenital heart disease (CHD), assessment by segmental fetal echocardiography is of great importance. This study sought to examine the concordance of expert fetal echocardiography and postnatal MRI of the heart at a high-volume paediatric heart centre. Methods: The data of two hundred forty-two fetuses have been gathered under the condition of full pre- and postnatal and the presence of a pre- and postnatal diagnosis of CHD. The haemodynamically leading diagnosis was determined for each test person and was then sorted into diagnostic groups. The diagnoses and diagnostic groups were used for the comparison of diagnostic accuracy in fetal echocardiography. Results: All comparisons between the diagnostic methods for detection of congenital heart disease showed an "almost perfect" (Cohen's Kappa > 0.9) strength of agreement for the diagnostic groups. The diagnosis made by prenatal echocardiography showed a sensitivity of 90–100%, a specificity and a negative predictive value of 97–100%, and a positive predictive value of 85–100%. The diagnostic congruence resulted in an "almost perfect" strength of agreement for all evaluated diagnoses (transposition of great arteries, double outlet right ventricle, hypoplastic left heart, tetralogy of Fallot, atrioventricular septal defect). An agreement of Cohen's Kappa > 0.9 was achieved for all groups, with exception of the diagnosis of double outlet right ventricle (0.8) in prenatal echocardiography compared to postnatal echocardiography. This study came to the result of a sensitivity of 88–100%, a specificity and negative predictive value of 97–100%, and a positive predictive value of 84–100%. The performance of cardiac magnetic resonance imaging (MRI) as an additional measure to echocardiography had an added value in the description of the malposition of the great arteries when diagnosed with double outlet right ventricle and in the detailed description of the anatomy of the lung circulation. Conclusions: Prenatal echocardiography could be shown to be a reliable method for detection of congenital heart disease when regarding the slightly lower accuracy of diagnosis for double outlet right ventricle and right heart anomalies. Furthermore, the impact of examiner experience and the consideration of follow-up examinations for further improvement of diagnosis accuracy may not be underestimated. The main advantage of an additional MRI is the possibility to obtain a detailed anatomic description of the blood vessels of the lung and the outflow tract. The conduction of further studies that include false-negative and false-positive cases, and studies that are not set within the high-risk-group, as well as studies in a less specialized setting, would allow the completion and investigation of possible differences and discrepancies when comparing the results that have been obtained in this study. [ABSTRACT FROM AUTHOR]

Background: Since myocardial work (MW) and left atrial strain are valuable for screening coronary artery disease (CAD), this study aimed to develop a novel CAD screening approach based on machine learning-enhanced echocardiography. Methods: This prospective study used data from patients undergoing coronary angiography, in which the novel echocardiography features were extracted by a machine learning algorithm. A total of 818 patients were enrolled and randomly divided into training (80%) and testing (20%) groups. An additional 115 patients were also enrolled in the validation group. Results: The superior diagnosis model of CAD was optimized using 59 echocardiographic features in a gradient-boosting classifier. This model showed that the value of the receiver operating characteristic area under the curve (AUC) was 0.852 in the test group and 0.834 in the validation group, with high sensitivity (0.952) and low specificity (0.691), suggesting that this model is very sensitive for detecting CAD, but its low specificity may increase the high false-positive rate. We also determined that the false-positive cases were more susceptible to suffering cardiac events than the true-negative cases. Conclusions: Machine learning-enhanced echocardiography can improve CAD detection based on the MW and left atrial strain features. Our developed model is valuable for estimating the pre-test probability of CAD and screening CAD patients in clinical practice. Trial registration: Registered as NCT03905200 at ClinicalTrials.gov. Registered on 5 April 2019. [ABSTRACT FROM AUTHOR]

Objective: To describe the experience of performing fetal echocardiography (FE) to detect fetal cardiac anomalies prenatally in an Ethiopian setting. Methods: A cross‐sectional study was conducted at St Paul's Hospital Millennium Medical College (Addis Ababa, Ethiopia), from October 1, 2019 to September 30, 2020. Data for FE cases (on a risk‐factor indication basis) performed at 22–24 weeks at the hospital during the study period were collected prospectively and analyzed using SPSSS version 23. Simple descriptive statistics were used to analyze the data. Results were presented as percentages and frequencies. Results: A total of 142 women who had FE were analyzed in this study. Fetal structural defect in other systems and maternal diabetes mellitus were the commonest indications for FE, seen in 48.2% (67/142) and 25.7% (36/142) of the participants, respectively. There were 5 cases (3.5%) of fetal cardiac anomalies among which were hypoplastic left heart syndrome, pulmonary stenosis, and cardiac tumor. Conclusion: The prevalence of fetal cardiac anomalies in this study was found to be 3.5%. Fetal structural defects and maternal diabetes mellitus were the commonest indications for FE which is consistent with findings from previous similar studies. Synopsis: Relying on local maternal‐fetal medicine experts for performing fetal echocardiography in high‐risk pregnancies in a low‐income setting is practical and allows early prenatal detection of fetal cardiac anomalies. [ABSTRACT FROM AUTHOR]

Background: Fetal dedicated echocardiography is the standard to measure the fetal cardiac axis. However, fetal screening ultrasound (US) or fetal dedicated echocardiography may be technically limited. Objective: The purpose of this study was to explore the accuracy of fetal cardiac magnetic resonance imaging (MRI) to measure the cardiac axis in fetuses with congenital heart disease as an adjunct to fetal dedicated echocardiography and to assess the predictive value of fetal cardiac MRI measurements in distinguishing healthy fetuses from fetuses with congenital heart disease. Materials and methods: This is a retrospective study of fetuses referred to our hospital for a fetal cardiac MRI from November 2019 to December 2021. Cardiac axes were measured in the 4-chamber view of the fetal heart using fetal cardiac MRI and dedicated echocardiography, or only using fetal cardiac MRI when screening US was technically limited. The fetuses were divided into a congenital heart disease group and a healthy control group. We used Bland–Altman analysis and the intraclass correlation coefficient (ICC) to assess the agreement of cardiac axis measurements in fetuses with congenital heart disease obtained by cardiac MRI and by fetal dedicated echocardiography. Receiver operating characteristic (ROC) curve analysis of the fetal cardiac axes in the congenital heart disease and healthy fetus groups assessed the predictive value of the cardiac axis measurements. Results: This retrospective study included 431 women (162 carrying fetuses with congenital heart disease, 269 carrying healthy fetuses). Cardiac axes were measured in the 162 fetuses with congenital heart disease using fetal cardiac MRI and dedicated echocardiography. Cardiac axes were measured in the 269 healthy control fetuses using fetal cardiac MRI when fetal screening US was technically limited. The interobserver analysis and intraobserver analysis showed that the cardiac axis measured by fetal cardiac MRI and fetal dedicated echocardiography was repeatable (ICC>0.90). In 162 fetuses with congenital heart disease, Bland–Altman analysis showed a strong agreement between cardiac MRI and fetal dedicated echocardiography measurements for the cardiac axis. The ICC for the cardiac axis values between cardiac MRI and fetal dedicated echocardiography measurements was 0.99. In fetuses with congenital heart disease, 64.2% (104/162) had an abnormal cardiac axis. For the fetal cardiac axis in both the 162 fetuses with congenital heart disease and the 269 healthy fetuses, the area under the ROC curve reached 0.85 (95% confidence interval: 0.80–0.89; P<0.0001). Conclusion: The cardiac axis can be accurately measured using fetal cardiac MRI when fetal dedicated echocardiography/fetal screening US is technically limited. The cardiac axis measurements by fetal cardiac MRI are consistent with known cardiac axis measurements by fetal dedicated echocardiography. The frequency of abnormal cardiac axis depends on the type of congenital heart disease. [ABSTRACT FROM AUTHOR]

Background: Atrioventricular septal defects (AVSDs) are screened and diagnosed usually rely on the imaging characteristics of fetal echocardiography (FE). However, diagnosis on images is heavily depended on sonographers’ experience and the quantitative data are rarely studied. Objective: This study aimed to realize the prenatal diagnosis of AVSDs by analyzing the quantitative data on FE. Methods: One hundred and thirteen cardiac quantitative data was analyzed in 370 normal and 49 AVSDs fetuses retrospectively. The top six with the highest diagnostic accuracy rate were acquired according to the area under the curve (AUC), and the diagnostic value of six variables was analyzed. Results: Six parameters obtained on the four-chamber view (4CHV), including the atrial to ventricular length ratio in end-diastole (AVLR-ED), AVLR-ED combined with the atrial to ventricular length ratio in end-systole (AVLR-ES), quantile score (Q score) of AVLR-ED, Q score of AVLR-ES, Q score of ventricle length in end-diastole (VL-ED), and AVLR-ES, were the top six with the highest diagnostic value, and the AUC was 0.99 (95%CI 0.99–1.00), 0.99 (95%CI 0.99–1.00), 0.99 (95%CI 0.98–1.00), 0.95 (95%CI 0.91–0.99), 0.93 (95%CI 0.87–0.99), and 0.91 (95%CI 0.83–1.00), respectively. And within the 20% false positive rate, the diagnostic sensitivity was greater than 100%, 100%, 100%, 90%, 90%, and 88%, respectively. Conclusions: Six variables could be used for prenatal diagnosis of AVSDs. Among them, AVLR-ED and Q score of AVLR-ED, obtained on the 4CHV, were more convenient to acquire and had higher diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Manual and intelligent navigation (i.e. fetal intelligent navigation echocardiography or FINE) by the operator are two methods to obtain standard fetal cardiac views from spatiotemporal image correlation (STIC) volumes. The objective was to compare the performance between manual and intelligent navigation (FINE) of the fetal heart by non-expert sonologists. In this prospective observational study, ten sonologists underwent formal training on both navigational methods. Subsequently, they were tested on their ability to obtain nine cardiac views from five STIC volumes of normal fetal hearts (19–28 gestational weeks) using such methods. The following parameters were determined for both methods: (1) success rate of obtaining nine cardiac views; (2) mean time to obtain nine cardiac views per sonologist; and (3) maximum number of cardiac views successfully obtained for each STIC volume. All fetal cardiac images obtained from 100 STIC volumes (50 for each navigational method) were reviewed by an expert in fetal echocardiography. Compared to manual navigation, FINE was associated with a significantly: (1) higher success rate of obtaining eight (excluding the abdomen view) appropriate cardiac views (92–100% vs. 56–88%; all p<0.05); (2) shorter mean time (minute:seconds) to obtain nine cardiac views (2:11 ± 0:37 vs. 15:49 ± 7:44; p<0.0001); and (3) higher success rate of obtaining all nine cardiac views for a given STIC volume (86 vs. 14%; p<0.001). When performed by non-expert sonologists, intelligent navigation (FINE) had a superior performance compared to manual navigation of the normal fetal heart. Specifically, FINE obtained appropriate fetal cardiac views in 92–100% of cases. [ABSTRACT FROM AUTHOR]

Shone's complex (SC) is characterized by sequential obstructions of left ventricular (LV) inflow and outflow. It can be associated with poor long-term prognosis when compared to Simple-Aortic Coarctation (S-CoA). We aimed to assess whether the degree of ventricular disproportion and 2D-speckle-tracking echocardiography (2D-STE) could improve the accuracy of prenatal prediction of SC. 75 consecutive fetuses were retrospectively enrolled from January 2010 to June 2021. Fetuses were divided into 4 groups (Group 1: SC; Group 2: S-CoA; Group 3: False Positive-Coarctation of the Aorta [FP-CoA]; group 4: controls). Comparisons for echocardiographic measures and myocardial deformation indices were performed. A receiver operating characteristic (ROC) analysis was performed on the MV/TV (mitral valve/tricuspid valve ratio) and LV GLS (global longitudinal strain) values to identify cut-offs to separate group 1 and 2 fetuses. SC fetuses showed a significant reduction in MV/TV when compared to S-CoA and FP-CoA fetuses (p<0.001). LV GLS in SC fetuses was significantly reduced compared to S-CoA fetuses (−13.3 ± 2.1% vs. −17.0 ± 2.2%, p=0.001). A cut-off value of 0.59 for MV/TV and −15.35% for LV GLS yielded a sensitivity of 76 and 82% and a specificity of 71 and 83% respectively in separating SC vs. S-CoA fetuses. SC fetuses showed a more severe degree of ventricular disproportion and a lower LV GLS compared to S-CoA, FP-CoA and control fetuses. MV/TV and GLS are both predictors of SC. These findings may improve the quality of prenatal parental counselling. [ABSTRACT FROM AUTHOR]

Objective: Congenital ventricular aneurysms located in the right ventricle are very rare abnormalities. Case(s): We describe a case of prenatal diagnosed right ventricle aneurysm which ended with favorable outcome. Fetal echocardiography demonstrated a 20x20 mm aneurysmal image outpouching from the basal region and free wall of the right ventricle in a 35- year-old multigravida woman at her 37th gestation week. This case had intermittent bradycardia in the postpartum first days. In pediatric cardiology examinations at the 1st, 3rd, 6th month and 1st year postnatally, it was observed that aneurysmatic formation partially regressed compared to the prenatal period. Conclusion: Prenatal diagnosis of these abnormalities allows to have a favorable prognosis via a multidisciplinary collaboration in intrauterine and postnatal period. [ABSTRACT FROM AUTHOR]

Aims: Measurement of myocardial strain using 2D speckle-tracking echocardiography can successfully quantify ventricular function, being considered superior to conventional echocardiography. This study aimed to establish reference intervals, interobserver agreements and reliability of two fetal echocardiographic parameters which reflect left ventricular myocardial function, left ventricular apical 4 chamber endo peak strain (AP4pLS) and ejection fraction (EF). Material and methods: We conducted a prospective study on 103 healthy fetuses. In each case, cardiac ultrasound images obtained were stored and afterwards were subject to offline 2D speckle-tracking echocardiographic analyses. In 15 randomly chosen subjects a second examiner also carried out an offline analysis of the 4-chamber view and the archived images, in order to assess inter-observer reproducibility and agreement level. Our study group was sub-divided into four different gestational age groups. Results: Reference ranges were established for the two measured parameters, AP4pLS and EF, which did not differ significantly between four different gestational age groups (p=0.98 and p=0.64) and neither correlated with gestational age progression (p=0.37 and p=0.08). An excellent level of agreement between the two examiners was found for the echocardiographic measurements, expressed through an intra-class correlation coefficient (ICC) value of 0.85 (0.62-0.94 for 95%CI) for AP4pLS and 0.78 (0.47-0.92 for 95% CI) for EF. Conclusions: Speckle tracking AP4pLS and EF parameters are useful for assessment of ventricular myocardial function in healthy fetuses and can be reliably reproduced by two different skilled examiners. Further studies conducted on larger populations are required to standardize reference values of fetal speckle-tracking measurements. [ABSTRACT FROM AUTHOR]

Background: The main challenge that faces management of valvular heart disease is that no medical therapies are known to decrease disease progression, or the resulting adverse outcomes on cardiac function. Cardiac imaging is essential to evaluate disease development and progression. It plays an important role in identifying valve lesion/dysfunction and to assess its severity as well as its impact on the cardiac function. Cardiac magnetic resonance (CMR) imaging may help in the assessment of Valvular heart disease. Our study was interested in studying Valvular lesions of different underlying pathologies and different forms of the resulting valve dysfunction (stenosis and/or regurgitation. The aim of this work was to assess role of cardiac MRI as a noninvasive tool in the evaluation of patients with Valvular heart disease in correlation with echocardiography. Methods: This prospective study included 40 patients suspected clinically and diagnosed by echocardiography with valvular heart disease. All patients were subjected to ECG monitoring, echocardiography and renal function test (blood urea, serum creatinine, estimation of glomerular filtration rate 'eGFR') and cardiac MRI examination. Results: There was fair agreement between echocardiography and CMR regarding the diagnosis of aortic regurgitation with kappa agreement coefficient (K = 0.242). There was perfect agreement between echocardiography and CMR regarding the grading of mitral stenosis with kappa coefficient (K = 0.813). There was moderate positive correlation between CMR-derived LV-EDV and MR volume as well as CMR-derived AR volume. Conclusions: Cardiac MRI added significant value to the assessment of valvular heart disease. It allows noninvasive, comprehensive evaluation of both valve lesion and its impact on the relevant cardiac chambers. It plays an important role in the assessment of patients with valvular affection with underlying congenital heart disease. CMR complements echocardiography and sometimes adds more additional valuable information. [ABSTRACT FROM AUTHOR]

Fetal growth restriction (FGR) is associated with an increased risk of adverse outcomes resulting from adaptive cardiovascular changes in conditions of placental insufficiency, leading to cardiac deformation and dysfunction, which can be evaluated with 2D speckle tracking echocardiography (2D-STE). The aim of the present study was to evaluate whether reduced fetal growth is associated with cardiac left-ventricle (LV) dysfunction, using 2D-STE software widely used in postnatal echocardiography. A prospective longitudinal cohort study was performed, and global (GLO) and segmental LV longitudinal strain was measured offline and compared between FGR and appropriate-for-gestational-age (AGA) fetuses throughout gestation. All cases of FGR fetuses were paired 1:2 to AGA fetuses, and linear mixed model analysis was performed to compare behavior differences between groups throughout pregnancy. Our study shows LV fetal longitudinal strain in FGR and AGA fetuses differed upon diagnosis and behaved differently throughout gestation. FGR fetuses had lower LV strain values, both global and segmental, in comparison to AGA, suggesting subclinical cardiac dysfunction. Our study provides more data regarding fetal cardiac function in cases of placental dysfunction, as well as highlights the potential use of 2D-STE in the follow-up of cardiac function in these fetuses. [ABSTRACT FROM AUTHOR]

Studies of the usefulness of transverse right ventricular (RV) shortening are limited. We retrospectively analyzed the CMR images of 67 patients (age: 50.8 ± 19.0 years; men: 53.7%; Control: n = 20, Overloaded RV (atrial septal defect): n = 15, Constricted RV (pericarditis): n = 17, Degenerated RV (arrhythmogenic right ventricular cardiomyopathy): n = 15) (all enrolled consecutively for each disease) in a single center. We defined RV longitudinal (fractional longitudinal change: FLC) and transverse (fractional transverse change: FTC) contraction parameters. We assessed the FTC/FLC (T/L) ratio on four-chamber cine CMR views and compared the four groups regarding the fractional parameters. FTC had a stronger correlation (R2 = 0.650; p < 0.001) with RV ejection fraction than that with FLC (R2 = 0.211; p < 0.001) in the linear regression analysis. Both FLC and FTC were significantly lower in the Degenerated RV and Constricted RV groups compared with those in the Control and Overloaded RV groups. The T/L ratio was significantly lower in the Degenerated RV group (p = 0.008), while the Overloaded RV (p = 0.986) and Constricted RV (p = 0.582) groups had preserved T/L ratios, compared with the Control group. Transverse shortening contributes to RV function more significantly compared with longitudinal contraction. Impaired T/L ratios may reflect RV myocardial degeneration. RV fractional parameters may help precisely understand RV dysfunction. [ABSTRACT FROM AUTHOR]

Purpose: Right ventricular (RV) function influences the outcome of hypoplastic left heart (HLH) patients. This study aimed to confirm the assumption of prenatal RV remodeling and possible influencing factors of myocardial restructuring using two-dimensional speckle tracking echocardiography (2D STE). Methods: This is a retrospective cross-sectional cohort study including HLH fetuses and gestational age-matched controls. Based on a four-chamber view, cine loops were stored with 60 frames per second. Global longitudinal peak systolic strain (GLPSS) of the RV was retrospectively determined and compared to healthy controls. Furthermore, HLH subgroups were built according to the presence of left ventricular endocardial fibroelastosis (LV-EFE) and restrictive foramen ovale (FO) to investigate the effect of these compromising factors on myocardial deformation. Results: A total of 41 HLH fetuses and 101 controls were included. Gestational age at fetal assessment was similarly distributed in both groups (controls: 26.0 ± 5.6 weeks vs. HLH: 29.1 ± 5.6 weeks). Relating to RV-GLPSS values, fetuses with HLH demonstrated lower mean values than healthy control fetuses (− 15.65% vs. − 16.80%, p = 0.065). Cases with LV-EFE (n = 11) showed significantly lower mean values compared to such without LV-EFE (n = 30) (RV-GLPSS: − 12.12% vs. − 16.52%, p = 0.003). No significant differences were observed for cases with FO restriction (n = 10). Conclusions: In HLH the RV undergoes prenatal remodeling, leading to an adaptation of myocardial function to LV conditions. Further explorations by STE should expand knowledge about RV contraction properties in HLH and its impact on surgical outcome. [ABSTRACT FROM AUTHOR]

Background: Congenital Heart Disease represents the most frequent fetal malformation. The lack of prenatal identification of congenital heart defects can have adverse consequences for the neonate, while a correct prenatal diagnosis of specific cardiac anomalies improves neonatal care neurologic and surgery outcomes. Sonographers perform prenatal diagnosis manually during the first or second-trimester scan, but the reported detection rates are low. This project's primary objective is to develop an Intelligent Decision Support System that uses two-dimensional video files of cardiac sweeps obtained during the standard first-trimester fetal echocardiography (FE) to signal the presence/absence of previously learned key features. Methods: The cross-sectional study will be divided into a training part of the machine learning approaches and the testing phase on previously unseen frames and eventually on actual video scans. Pregnant women in their 12–13 + 6 weeks of gestation admitted for routine first-trimester anomaly scan will be consecutively included in a two-year study, depending on the availability of the experienced sonographers in early fetal cardiac imaging involved in this research. The Data Science / IT department (DSIT) will process the key planes identified by the sonographers in the two- dimensional heart cine loop sweeps: four-chamber view, left and right ventricular outflow tracts, three vessels, and trachea view. The frames will be grouped into the classes representing the plane views, and then different state-of-the- art deep-learning (DL) pre-trained algorithms will be tested on the data set. The sonographers will validate all the intermediary findings at the frame level and the meaningfulness of the video labeling. Discussion: FE is feasible and efficient during the first trimester. Still, the continuous training process is impaired by the lack of specialists or their limited availability. Therefore, in our study design, the sonographer benefits from a second opinion provided by the developed software, which may be very helpful, especially if a more experienced colleague is unavailable. In addition, the software may be implemented on the ultrasound device so that the process could take place during the live examination. Trial registration: The study is registered under the name „Learning deep architectures for the Interpretation of Fetal Echocardiography (LIFE)", project number 408PED/2020, project code PN-III-P2–2.1-PED-2019. Trial registration: ClinicalTrials.gov, unique identifying number NCT05090306, date of registration 30.10.2020. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the feasibility and accuracy of fetal intelligent navigation echocardiography (FINE) for the prenatal diagnosis of congenital heart disease (CHD) by inexperienced and experienced operators. Method: In this prospective study, all volume data sets from 120 fetuses with a broad spectrum of CHD were acquired using spatiotemporal image correlation technology. The prenatal diagnostic procedures were performed by two operators with different experience (beginner: 1 year and expert: 15 years) using FINE and traditional fetal echocardiography. Data were analyzed on the time of examination and acquisition of results. Results: Diagnoses made by FINE and traditional echocardiography were completely consistent with the final diagnosis of CHD in 98 (81.66%) versus 20 (16.66%) (P < 0.001) beginners and 87.50% (n = 105) versus 101 (84.16%) experts, respectively. On the contrary, there was significant difference using traditional echocardiography (16.66% versus 84.16%, P < 0.001) by two examiners. Furthermore, the examination time decreased when using FINE compared with using traditional echocardiography (beginner operators: 4.54 ± 1.03 min versus 20.58 ± 3.36 min, P < 0.001; expert operators: 3.89 ± 0.96 min versus 12.73 ± 1.62 min, P < 0.001). Conclusion: Based on our results, a prenatal diagnosis of CHD can be made with high feasibility and accuracy using FINE compared with traditional fetal echocardiography for beginner operators. Synopsis: Intelligent navigation echocardiography was effective and accurate for the diagnosis of congenital heart disease compared with traditional echocardiography when performed by less‐experienced operators. [ABSTRACT FROM AUTHOR]

Objectives: To compare the diagnostic accuracy of cardiac Computed Tomography (CT) and echocardiography for the diagnosis of congenital heart diseases (CHD) at Rehman Medical Institute (RMI), Peshawar. Methodology: We conducted a cross sectional study at Rehman Medical Institute between January 2020 to July 2022. Patients of different ages referred for suspicion of congenital heart diseases were enrolled. The data was collected prospectively which included demographics, Echocardiography findings, CT scan results and procedure notes. Data was analyzed on SPSS the results of descriptive variables expressed as median and percentile. A p-value <0.05 was considered significant. Results: We included 129 patients, with 73 male and 56 females having age from few days to 18 years. The malformations were divided into intra and extra cardiac groups. 665 malformations were confirmed and analyzed keeping surgical and conventional angiography findings as gold standard. Among these 283 were intra and 99 extra cardiac findings. The echo and CT scan missed 2 and 4 intracardiac anomalies respectively. In case of extracardiac anomalies echo missed 14 anomalies however CT correctly diagnosed all. Both intra and extracardiac results are significant with a p value <0.05. Conclusion: We conclude that Echocardiography is preferred modality for intracardiac anomalies evident by 99.3% diagnostic accuracy while CTA provides better demonstration of extra cardiac abnormalities having diagnostic accuracy of 99.9%. Echocardiography and CTA are both complementary for assessment and evaluation of congenital heart diseases acting as guide to surgery. [ABSTRACT FROM AUTHOR]

Objective: To determine if inter-twin differences in fetal echocardiographic findings are associated with fetal survival in monochorionic pregnancies complicated by twin-to-twin transfusion syndrome (TTTS). Methods: This study included women who underwent laser surgery for TTTS between 2012 and 2018 at a single institution. Echocardiographic cardiac parameters in the donor and recipient twins were compared using Z-scores and regression analyses (adjusted for confounding variables) to determine whether any measurable inter-twin differences were associated with neonatal survival at birth. Results are expressed as (Odds ratio [95% confidence interval], p-value). Results: Fetal echocardiography and delivery information was available in 124 TTTS cases. Dual live-birth occurred in 72% and at least one live-birth was seen in 89% of cases. Results: Sixty-four percent (51/79) of recipient twins had evidence of cardiac dysfunction compared to 10% (8/79) of the donor twins (p < .01). In the logistic regression, inter-twin differences in left ventricle short axis dimension (0.62[0.44–0.87], p < .01), aortic valve diameter (0.67[0.45–0.99], p = .047), peak systolic velocity across the pulmonary artery (PA-PSV) (0.09[0.01–0.53], p < .01) and mitral valve diameter (0.56[0.38–0.84], p < .01) were associated with lower dual twin survival at birth. Conclusion: Inter-twin differences in left cardiac geometry and function are associated with decreased survival at delivery in TTTS. [ABSTRACT FROM AUTHOR]

Objective This study aimed to identify new functional echocardiographic features of fetal foramen ovale (FO) to predict the need of urgent balloon atrial septostomy (BAS) in neonates with simple dextro-transposition of the great arteries (d-TGA). Method Single-center prospective study of fetuses, who had prenatal echocardiographic examination <30 days before delivery and fetal diagnosis of simple d-TGA. The subjects were divided according to the need of BAS within the first 24 h after neonatal birth and before arterial switch operation. We analyzed following parameters: FO diameter, pulmonary venous maximal velocity, new FO flap tracings index analyzed by M-mode echocardiography. Results Out of 130 fetuses, 12 patients were included. Cutoff value of FO index provided maximum sensitivity (100%) and negative predictive value (100%) and cutoff value of FO index multiplied by FO diameter provided maximum specificity (100%) and positive predictive value (100%) in fetuses with fetal d-TGA in predicting need of urgent BAS. Conclusion FO index could potentially be used to predict postnatal haemodynamic stability in fetuses with simple d-TGA. FO index multiplied by FO diameter could potentially be used to predict prenatally the need of urgent BAS following the birth. [ABSTRACT FROM AUTHOR]

Background Speckle tracking technology has been applied to assess ventricular deformation throughout the cardiac cycle. An electronic four dimensional probe that allows rapid acquisition of electronic spatio-temporal image correlation volumes (eSTIC) has been recently introduced. Objectives The aim of our study was to investigate whether e-STIC acquisition improves deformation analyses reproducibility. Study design We recruited fetuses between 20 and 40 weeks of gestation. We obtained a 2D video clip and an e-STIC volume of a four-chamber view. We focused on left ventricular global strain (LV-GS) and left ventricular ejection fraction (LV-FE). Intraobserver, interobserver and intermethod agreement were assessed by means of intraclass correlation coefficient (ICC) and illustrated by Bland-Altman plots. Systematic differences between measurements were assessed using a paired t-test. Results The mean difference between LV-GS values obtained with e-STIC and 2D analysis was −0.10 (95% CI −2.28, 2.08). No systematic differences were found between the two techniques for LV-GS values (p-value = .927). The mean difference between LV-FE values obtained with e-STIC and 2D analysis was 7.55 (95% CI 4.16, 10.95; p-value <.001). The inter-rater reliability of LV-GS was moderate-to-substantial for both e-STIC and 2D. The inter-rater reliability of LV-FE obtained via e-STIC was superior to that obtained via 2D analysis. The intra-rater reliability of LV-GS obtained with e-STIC was superior to that obtained with 2D analysis (ICC 0.857; 95% IC 0.761–0.917). The intra-rater reliability of LV-FE obtained via e-STIC was superior to that obtained via 2D analysis (ICC 0.647; IC 0.51–0.783). Conclusions e-STIC seems to be a better technique than 2D analysis for intra-rater reliability of LV-GS. 4D acquisition might improve intrinsic limitations of speckle tracking echocardiography. [ABSTRACT FROM AUTHOR]

Isolated transposition of the great arteries (TGA) is a congenital heart disease that presents with severe cyanosis after birth and a fetal diagnosis is crucial for the preservation of life. The I‐shaped sign (I‐sign) is useful as a fetal screening method for TGA. We herein present a tricky fetal case of isolated TGA with a side‐by‐side position of the great arteries and no I‐sign. Severe cyanosis immediately after birth necessitated urgent interventions. A potentially fatal outcome was prevented by a prenatal diagnosis. In the fetal diagnosis of isolated TGA, it is important to not only detect the I‐sign, but also conventionally examine the ventricular outflow tract. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to determine the anxiety levels of pregnant women who were referred to a tertiary center for fetal echocardiography (FE) and the effect of FE results on maternal anxiety.Methods: This prospective study was conducted between January 2020 and February 2021 and included 118 pregnant women. The anxiety levels of the participants were evaluated with the Spielberger State-Trait Anxiety Inventory, which evaluates state (STAI-I) and trait (STAI-II) anxiety. STAI-I and STAI-II were administered to participants at first admission using a standard interview technique prior to FE. After the FE was completed, a structured interview was performed and the state anxiety index (STAI-I-R) was re-administered to the participants.Results: Severe congenital heart disease (CHD) was detected in 63 (53.4%) fetuses. The participants' mean STAI-I scores were significantly higher than their mean STAI-II scores (44.19 ± 8.56 and 41.98 ± 5.98, respectively, t = 2.59 and p = 0.011). In pregnant women with fetuses with severe CHD, STAI-I-R scores were significantly lower compared to STAI-I scores (43.48 ± 7.97 and 46.28 ± 7.18, respectively, t = 2.13 and p = 0.037).Conclusion: Referral for FE is associated with increased maternal anxiety, and a structured interview may result in reduced anxiety levels even in those with abnormal FE. [ABSTRACT FROM AUTHOR]

This study aimed to screen for the eligibility of correction in cases of adult congenital heart disease (CHD). Pulmonary to systemic flow ratios (Qp/Qs) > 1.5 and pulmonary to systemic vascular resistance ratios (Rp/Rs) < 1/3, acquired by right heart catheterization (RHC), are two essential parameters. Nonetheless, performing RHC at every follow-up is impractical and even harmful. Thus, it is important to establish a model to predict Qp/Qs and Rp/Rs status before a RHC confirmation, using echocardiography parameters. A total of 1,785 patients with adult CHD were enrolled and randomly assigned to the derivation or validation groups. Echocardiogram parameters of the 974 patients in the derivation group were considered candidate predictors for surgery eligibility (Qp/Qs > 1.5 and Rp/Rs < 1/3). Binary logistic regression analyses were performed to identify the independent predictors and establish a scoring system. The scoring system was further examined in the validation group using a receiver operating characteristic (ROC) analysis. Estimated pulmonary artery systolic pressure, velocity through the pulmonary valve, and diameters of the left and right atria were identified as independent predictors. The area under the ROC curve of the predictive value in the validation group and its pre- and post-tricuspid valve malformation subgroups were 0.87 (95% confidence interval [CI]: 0.84−0.90, p < 0.01), 0.86 (95% CI: 0.82−0.91, p < 0.01), and 0.85 (95% CI: 0.79−0.90, p < 0.01), respectively. This scoring system could augment flexibility and convenience for pre-screening CHD patients' eligibility for surgery, before RHC. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: In this study, we investigated whether maternal hypothyroidism has a role in the cardiac output (CO) of the fetus or not. Methods: Pregnant women between 33 and 37 gestational weeks known to have hypothyroidism and using levothyroxine were accepted as the case group. Gestational age‐matched healthy euthyroid pregnant women constituted the control group. Fetal echocardiography was performed. Diameters and the velocity waveform of the pulmonary artery (PA) and aortic valves were measured. Velocity time integral (VTI) was also measured from the ventricular outflow tract. CO was calculated using VTI × π (Aortic Valve or Pulmonary Valve diameter/2) 2 × heart rate formula. Results: The aortic and PA annulus were measured larger in the control group. (p =.003, p =.005, respectively). Furthermore, the right and left CO of the case group were lower than the control group. Whereas the mean combined CO (ml/min) of the case group was 674.8 ± 146.2, it was 827.8 ± 167.9 in the control group (p <.001). Additionally, a negative correlation was observed between thyroid‐stimulating hormone and aortic VTI (r:−.480; p:.006). Conclusion: The findings of our study suggest that the CO of the fetus may be affected by maternal hypothyroidism [ABSTRACT FROM AUTHOR]

Background: The prenatal diagnosis of coarctation of aorta (CoA) remains a major challenge, as the false-positive diagnosis is fairly common. The purpose of this study was to find some useful prenatal sonographic markers compatible with the postnatal diagnosis of CoA. Methods: The study included fetuses suspected of CoA in the second and third-trimester ultrasound tests. All cases were examined by fetal echocardiography at a single ultrasound clinic between 2019 and 2020. The proportion of right and left ventricular size was assessed and ductal/isthmus diameter ratio was measured. A comparison was drawn between the results of neonates with neonatal CoA and neonates without CoA. Results: Of 20 fetuses with suspected prenatal CoA, 3 (15%) had neonatal CoA. The mean ductal/isthmus ratio was significantly higher in the neonates with CoA (1.96 vs. 1.46; p< 0.001). The diagnostic power of ductal/isthmus ratio to detect CoA with a cut point of 1.53 had a sensitivity and specificity of 100% and 70.6%, respectively, a positive and negative predictive value of 37.5% and 100%, respectively, and an overall accuracy of 75%. Conclusion: The ductal/isthmus ratio diameter and ventricular disproportion are significant sonographic markers for the prenatal diagnosis of CoA, and the ductal/isthmus ratio has high sensitivity and specificity compared to postnatal findings. [ABSTRACT FROM AUTHOR]

Transthoracic echocardiography (TTE) and cine cardiac magnetic resonance imaging (CMR) are established imaging methods of the aortic root. We aimed to evaluate the comparability of measurements in TTE and standard cine CMR sequences of the aortic root. Our study included 741 subjects (mean age 63.5 ± 8 years, 43.7% female) from the Hamburg City Health Study (HCHS). Subjects underwent CMR and TTE. Aortic root measurements were performed at the level of the aortic annulus (AoAn), sinus of Valsalva (SoV), and sinotubular junction (STJ) by standard cine CMR in left ventricular long axis and left ventricular outflow tract view. Measurements were performed applying the leading-edge to leading-edge (LL) convention and inner-edge to inner-edge (II) convention in TTE and the II convention in CMR. Inter correlation coefficients (ICCs) demonstrated high inter- and intraobserver reproducibility for CMR and TTE measurements of SoV and STJ (ICCs 0.9–0.98) and moderate reproducibility for AoAn (ICCs 0.68–0.91). CMR measurements of SoV and STJ showed strong agreement with TTE: while correlations were comparable (r = 0.75–0.85) bias was lower with TTE II (bias − 0.1 to − 0.74) versus TTE LL measurements (mean bias − 1.49 to − 2.58 mm). The agreement for AoAn was fair (r = 0.51–0.57) with variable bias (mean bias 0.39–3.9). Standard cine CMR and TTE derived aortic root measurements are reproducible and comparable with higher agreement for TTE II instead of LL measurements. These results support an interchangeable application of TTE and standard CMR for screening of aortic root diseases thereby possibly reducing redundant multimodality imaging. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of nifedipine used for tocolysis on cardiac morphology and functions. Methods: The study included 47 pregnant women diagnosed with preterm labor at 32–33 weeks. Fetal echocardiographic evaluation was performed with two‐dimensional (2D) imaging, M‐mode, pulsed wave (PW) Doppler, and tissue Doppler imaging (TDI) before and after the 48th hour of nifedipine treatment. Results: No significant change was observed in Doppler parameters (pulsatility indices of the umbilical artery, middle cerebral artery, ductus venosus) and cardiac morphology (cardiothoracic ratio, end‐diastolic longitudinal diameters, sphericity indices, wall thickness) after nifedipine treatment. The parameters obtained with TDI (e', a', s', e'/a', E/e' of mitral and tricuspid valves), M‐ mode (TAPSE, MAPSE), pulsed Doppler (myocardial performance index, left cardiac output, right cardiac output, tricuspid E, A waves, tricuspid E/A ratio, mitral E, A waves, mitral E/A ratio) did not change after nifedipine treatment. Conclusion: To date, this is the first study to examine the effects of nifedipine on the fetal heart using the TDI. Since nifedipine is a drug that is frequently used and well‐tolerated in the prevention of preterm labor, it is crucial that it does not cause changes in fetal cardiac parameters during tocolysis. Therefore, we used TDI in addition to conventional methods to evaluate the effect of nifedipine, which is frequently used in obstetrics, on cardiac functions in the early period. Nifedipine treatment seems not to affect systolic or diastolic functions. This indicates that nifedipine is reliable on cardiac functions and morphology in pregnancies treated for preterm labor. [ABSTRACT FROM AUTHOR]

Aim: To compare the evaluation of left ventricular function by spatio‐temporal image correlation (STIC) between fetal growth restriction (FGR) fetuses and normal fetuses. Methods: Forty‐two FGR fetuses and 50 normal fetuses with gestational age ranging from 28 to 35 weeks, were chosen for the study group and control group, respectively. The fetal heart was acquired using the STIC modality, beginning with a four‐chamber view. A 7.5–12.5 s acquisition time and 20–35°angle of the acquisition were used for the acquisition. The resulting STIC dataset was saved for offline analysis. Ventricular volumes were measured using the Virtual Organ Computer‐aided Analysis (VOCAL) mode, where the observer defines the contours of the ventricle and traces the endocardia. Stroke volume (SV) = end diastolic volume (EDV)−end systolic volume (ESV) and ejection fraction (EF) = SV/EDV × 100%. The data of the two groups were analyzed. Results: (1) SV increased with fetal growth in both groups and was positively correlated with gestational age (p <.01), whereas EF remained constant throughout gestation and had no correlation with gestational age (p >.05). (2) There was no difference found in EF between the two groups, (p >.05), SV was significantly lower in FGR group than those in the normal group (p <.01). Conclusion: The STIC is a precise method for calculating fetal ventricular volume changes and functions. Reduced SV occurred at the initial stage of fetal deterioration before the discovery of abnormal EF in FGR fetuses, indicating cardiac dysfunction. SV could be a sensitive indicator of cardiac dysfunction. The use of EF to assess fetal cardiac function is not perfect. [ABSTRACT FROM AUTHOR]

One of the most successful achievements of fetal intervention is the pharmacologic management of fetal arrhythmias. This management usually takes place during the second or third trimester. While most arrhythmias in the fetus are benign, both tachy‐ and bradyarrhythmias can lead to fetal hydrops or cardiac dysfunction and require treatment under certain conditions. This review will highlight precise diagnosis by fetal echocardiography and magnetocardiography, the 2 primary means of diagnosing fetuses with arrhythmia. Additionally, transient or hidden arrhythmias such as bundle branch block, QT prolongation, and torsades de pointes, which can lead to cardiomyopathy and sudden unexplained death in the fetus, may also need pharmacologic treatment. The review will address the types of drug therapies; current knowledge of drug usage, efficacy, and precautions; and the transition to neonatal treatments when indicated. Finally, we will highlight new assessments, including the role of the nurse in the care of fetal arrhythmias. The prognosis for the human fetus with arrhythmias continues to improve as we expand our ability to provide intensive care unit–like monitoring, to better understand drug treatments, to optimize subsequent pregnancy monitoring, to effectively predict timing for delivery, and to follow up these conditions into the neonatal period and into childhood. Coordinated initiatives that facilitate clinical fetal research are needed to address gaps in knowledge and to facilitate fetal drug and device development. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes mellitus (GDM) is a complication of pregnancy strongly associated with an increased risk of structural fetal abnormalities. As the fetal heart grows quickly during the late‐term pregnancy period, it is important to understand fetal heart growth before birth. This study explored how GDM affects fetal heart growth by evaluating basic echocardiography indicators during late pregnancy. Methods: This prospective, longitudinal study included 63 GDM patients (GDM group) and 67 healthy pregnant women (control group). All subjects underwent fetal echocardiography scans at gestational weeks 28–32, 32–36, and 36–40. Twelve echocardiographic indicators were assessed at each observation and analyzed by using a mixed model. Results: The left atrial diameter (LA) and left ventricular end‐diastolic diameter (LV) similarly increased from the first to the third observation. The right ventricular end‐diastolic diameter (RV) was significantly different between the groups, and a group × time interaction was detected. The tricuspid annular peak systolic velocity (s') increased more rapidly in the GDM than the control group during the first to second observations, and the group × time interaction was significant. The increase in the tricuspid annular plane systolic excursion (TAPSE) of the GDM group was "slow‐fast", while that of the control group was "fast‐slow", during three observations. After adjusting covariates, the group difference and interaction effect of TAPSE and RV remained significant. Conclusions: The differences in fetal right heart indicators between the GDM and control groups suggest that GDM may affect the structure and functional growth of the fetal right heart during late‐term pregnancy. [ABSTRACT FROM AUTHOR]

4 DeVore GR, Satou G, Sklansky M. Comparing the Non-Quiver and Quiver Techniques for Identification of the Endocardial Borders Used for Speckle-Tracking Analysis of the Ventricles of the Fetal Heart. In this paper, we obtained reliable reference values for fetal global longitudinal strain (GLS) and strain rate (GLSR) using the 2D Cardiac Performance 1.2 software program by TOMTEC Imaging Systems GmbH (Munich, Germany). We thank Dr DeVore for his interest in our paper[1]. [Extracted from the article]

(1) Objective: To scrutinize the reliability and the clinical value of routinely used fetal intelligent navigation echocardiography (FINE) static mode (5DHeartStatic™) for accelerated semiautomatic volumetric assessment of the normal fetal heart. (2) Methods: In this study, a total of 296 second and third trimester fetuses were examined by targeted ultrasound. Spatiotemporal image correlation (STIC) volumes of the fetal heart were acquired for further volumetric assessment. In addition, all fetal hearts were scanned by a fast acquisition time volume (1 s). The volumes were analyzed using the FINE software. The data were investigated regarding the number of properly reconstructed planes and cardiac axis. (3) Results: A total of 257 volumes were included for final analysis. The mean gestational age (GA) was 23.9 weeks (14.3 to 37.7 weeks). In 96.9 (standard acquisition time, FINE standard mode) and 94.2% (fast acquisition time, FINE static mode) at least seven planes were reconstructed properly (p = 0.0961, not significant). Regarding the overall depiction rate, the standard mode was able to reconstruct 96.9% of the planes properly, whereas the static mode showed 95.2% of the planes (p = 0.0098). Moreover, there was no significant difference between the automatic measurement of the cardiac axis (37.95 + 9.14 vs. 38.00 + 8.92 degrees, p = 0.8827, not significant). (4) Conclusions: Based on our results, the FINE static mode technique is a reliable method. It provides similar information of the cardiac anatomy compared to conventional STIC volumes assessed by the FINE method. The FINE static mode has the potential to minimize the influence of motion artifacts during volume acquisition and might therefore be helpful concerning volumetric cardiac assessment in daily routine. [ABSTRACT FROM AUTHOR]

Background: Focused cardiac ultrasound examination (FoCUS) is rapidly emerging for point‐of‐care cardiac assessment using hand‐carried ultrasound (HCU) devices. A specific FoCUS protocol for horses and adequate training guidelines currently are not available. Hypothesis: To gain knowledge about the training necessary to become proficient in performing FoCUS using a HCU device. Animals: Three healthy Warmblood horses were used for practical training of veterinarians and veterinary students in equine focused cardiac ultrasound (eFoCUS). Methods: Prospective educational study. An eFoCUS protocol and 1‐day training course were developed. Pre‐ and post‐course written tests were administered to participants to evaluate proficiency in knowledge of echocardiography and echocardiographic pathology. A post‐course practical examination involved performing eFoCUS and storage of representative images. Images were evaluated using an image quality score and compared between participants with some practical experience and participants with no practical experience. Results: Participants' knowledge of echocardiography increased significantly. Recognition of echocardiographic pathology pre‐course ranged from 40% to 90% (mean score, 65.7%) and post‐course from 85% to 100% (mean score, 92%). Eighteen of 21 participants were proficient in performing eFoCUS with a median image quality score of 79% (range, 42%‐95%). Image quality did not differ between participants with some practical experience compared to participants with no experience. Conclusions and Clinical Importance: Veterinarians and veterinary students independent of previous experience can become proficient in performing eFoCUS after completion of a 1‐day training course. [ABSTRACT FROM AUTHOR]

Aim: We aimed to examine fetal cardiac output (CO) in patients who recovered from severe acute respiratory syndrome Coronavirus 2 (SARS‐CoV‐2) infection. Materials: This prospective study included 48 pregnant women recovered from SARS‐CoV‐2 infection and 50 control cases. SARS‐CoV‐2 infection was diagnosed by polymerase chain reaction (PCR) test in patients. Fetal echocardiographic evaluations were performed at 24–37 weeks of gestation in pregnant women who recovered from the infection and control group. Results: The median value of ultrasound evaluation was 34 (2.6) weeks of gestation in the recovery from the SARS‐CoV‐2 infection (RSI) group, and 32 (7.6) weeks in the control group (p =.565). Left cardiac output (LCO) z score was significantly lower in the RSI group than the control group (p =.041). LCO and combine cardiac output (CCO) z score were significantly lower in the severe disease group than mild, moderate disease groups, and controls (p =.019 and p =.013). CCO (ml/min/kg) was decreased in the severe disease group when compared with control and mild disease groups (p =.044). Conclusion: In the present study, fetal cardiac output in pregnant women who recovered from SARS‐CoV‐2 infection was found to be significantly reduced in those with severe disease, while there was no significant difference in mild and moderate cases. Placental dysfunction and inflammatory cytokines might cause fetal cardiac changes. Further studies could be clarified on the impact of SARS‐CoV‐2 infection on fetal cardiac function. [ABSTRACT FROM AUTHOR]