MR imaging of fetal cardiac malposition and congenital cardiovascular anomalies on the four-chamber view
© The Author(s) 2016
Received: 13 June 2016
Accepted: 14 July 2016
Published: 29 July 2016
Fetal echocardiography is the method of choice to visualize the fetal congenital cardiovascular anomalies. However, there are some disadvantages. Fetal cardiac magnetic resonance imaging (MRI) has the potential to complement ultrasound in detecting congenital cardiovascular anomalies. This pictorial review draws on our experience about fetal cardiac MRI; it describes the four-chamber view on fetal cardiac MRI and important clues on an abnormal four-chamber view to the diagnosis of fetal congenital cardiovascular anomalies.
KeywordsFetal heart Congenital heart disease Fetal echocardiography Cardiac magnetic resonance imaging Prenatal diagnosis
Abnormalities of the cardiovascular system are the most common congenital diseases in the fetus and the first cause of infant mortality (Johnson et al. 2014). Without a doubt, Echocardiography is the method of choice to visualize the fetal cardiac cardiovascular abnormalities.
Unlike fetal echocardiography imaging, cardiovascular magnetic resonance (CMR) is relatively unaffected by maternal and fetal conditions such as maternal obesity, uterine myoma, twins, oligohydramnios, fetal position and rib calcification, which particularly impair sonographic visualization of the fetal heart (Donofrio et al. 2014; Wielandner et al. 2013). Fetal CMR imaging has the potential to complement ultrasound in detecting cardiovascular malformations and extracardiac anomalies (Donofrio et al. 2014; Wielandner et al. 2013; Manganaro et al. 2014; Dong et al. 2013).
Cardiac positional anomalies
Cardiac and ventricle size anomalies
Fetal cardiac size anomalies also are very important and should be secondly assessed. The cardiac size relative to the thorax may be evaluated from four-chamber view CMR images. Cardiac malformations associated with cardiomegaly and/or different sizes of the cardiac chambers are also easily recognized on four-chamber view of fetal CMR.
Cardiac septum defects
Cardiac tumor and other malformations
The four-chamber view images on fetal CMR can identify cardiac malposition, cardiac malformations associated with cardiomegaly, different sizes of the cardiac chambers, large cardiac septum defects, cardiac tumors and others. Although certain fetal heart abnormalities will not be consistently identified such as small ventricular septum defect and valvular stenosis, the four-chamber view on fetal CMR still can provide some diagnostic information for fetal heart anomalies.
SZD acquired the fetal MR and echocardiography data and drafted the manuscript. MZ provided guidance and was involved with editing the final manuscript. Both authors read and approved the final manuscript.
This work was supported by three funds from National Natural Science Foundation of China (30970795, 81101032 and 81571628).
The authors declare that they have no competing interests.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
- Atalay S, Aypar E, Uçar T, Altuğ N, Deda G, Teber S et al (2010) Fetal and neonatal cardiac rhabdomyomas: clinical presentation, outcome and association with tuberous sclerosis complex. Turk J Pediatr 52:481–487Google Scholar
- Avni FE, Massez A, Cassart M (2009) Tumours of the fetal body: a review. Pediatr Radio 139:1147–1157View ArticleGoogle Scholar
- Brugger PC (2010) MRI of the fetal heart. In: Prayer D (ed) Fetal MRI, 1st edn. Springer, Heidelberg, pp 247–257View ArticleGoogle Scholar
- Craig B (2006) Atrioventricular septal defect: from fetus to adult. Heart 92:1879–1885View ArticleGoogle Scholar
- Dong SZ, Zhu M (2015) Pattern-based approach to fetal congenital cardiovascular anomalies using the transverse aortic arch view on prenatal cardiac MRI. Pediatr Radiol 45:743–750View ArticleGoogle Scholar
- Dong SZ, Zhu M, Li F (2013) Preliminary experience with cardiovascular magnetic resonance in evaluation of fetal cardiovascular anomalies. J Cardiovasc Magn Reson 15:40View ArticleGoogle Scholar
- Donofrio MT, Moon-Grady AJ, Hornberger LK, Copel JA, Sklansky MS, Abuhamad A et al (2014) Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation 129:2183–2242View ArticleGoogle Scholar
- Falkensammer CB, Ayres NA, Altman CA, Ge S, Bezold LI, Eidem BW et al (2008) Fetal cardiac malposition: incidence and outcome of associated cardiac and extracardiac malformations. Am J Perinatol 25:277–281View ArticleGoogle Scholar
- Freud LR, McElhinney DB, Marshall AC, Marx GR, Friedman KG, del Nido PJ et al (2014) Fetal aortic valvuloplasty for evolving hypoplastic left heart syndrome: postnatal outcomes of the first 100 patients. Circulation 130:638–645View ArticleGoogle Scholar
- Goel R, Aggarwal N, Lemmon ME, Bosemani T (2016) Fetal and maternal manifestations of tuberous sclerosis complex: value of fetal MRI. Neuroradiol J 29:57–60View ArticleGoogle Scholar
- Harold JG (2014) Cardiology patient page. Screening for critical congenital heart disease in newborns. Circulation 130:e79–e81View ArticleGoogle Scholar
- Johnson LC, Lieberman E, O’Leary E, Geggel RL (2014) Prenatal and newborn screening for critical congenital heart disease: findings from a nursery. Pediatrics 34:916–922View ArticleGoogle Scholar
- Manganaro L, Savelli S, Di Maurizio M, Francioso A, Fierro F, Tomei A et al (2009) Fetal MRI of the cardiovascular system: role of steady-state free precession sequences for the evaluation of normal and pathological appearances. Radiol Med 14:852–870View ArticleGoogle Scholar
- Manganaro L, Vinci V, Bernardo S, Sollazzo P, Sergi ME, Saldari M et al (2014) Magnetic resonance imaging of fetal heart: anatomical and pathological findings. J Matern Fetal Neonatal Med 27:1213–1219View ArticleGoogle Scholar
- Recio Rodríguez M, Martínez de Vega V, Cano Alonso R, Carrascoso Arranz J, Ten Martínez P, Pérez Pedregosa J (2012) MR imaging of thoracic abnormalities in the fetus. Radiographics 32:E305–E321View ArticleGoogle Scholar
- Wielandner A, Mlczoch E, Prayer D, Berger-Kulemann V (2013) Potential of magnetic resonance for imaging the fetal heart. Semin Fetal Neonatal Med 18:286–297View ArticleGoogle Scholar