الفهرس 
EmbryologyOnly 14 pages are availabe for public view
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Abstract
F
etal cardiac examination is an important part of obstetrical follow-up during pregnancy and impacts future care of the infant. Fetal diagnosis allows for specially tailored preparations to be made for the delivery and early care of an infant with congenital heart disease (CHD). CHD affects nearly 9 per 1,000 live births and represents the largest subclass of congenital anomalies (Loomba et al., 2011).
Imaging is fundamental to the diagnosis of CHD and is required at all stages of patient care. from the fetal stage onwards, imaging outlines anatomy and physiology, helps to refine management, evaluates the consequences of interventions and helps guide prognosis (Ntsinjana et al., 2011).
Conventional fetal echocardiography is the mainstay for prenatal diagnosis of congenital cardiac lesions, based on its ease of use, availability and high diagnostic accuracy. However, individual fetal and maternal factors can have a deleterious effect on the quality of ultrasound imaging (Lloyd et al., 2016).
The usual timing of fetal echocardiography for the premature diagnosis of congenital heart disease is at approximately 20–26 weeks of gestation. During the later phases of gestation, the development of certain conditions (e.g., relative reduction of the amniotic fluid volume and intensification of calcification in the ribs) may impair the quality of the fetal echocardiography examination (Kasprian et al., 2006).
The fetal echocardiography is the standard and primary modality used for fetal imaging. it is widely available, easy to be applied, low cost, safe for fetus and mother allows real time imaging. However, there are some limitations such as, oligohydramnios, obesity and inappropriate fetal position, which reduces its effectiveness and evaluation of some parts of body and complex syndromes as well.
A lot of congenital cardiovascular anomalies can be found some clues at the two views (four chamber view and transverse aortic arch view). They concluded that fetal echo still was the first method of choice in fetal CHD. Now MRI can become an alternative imaging modality for fetal CHD (Zhu, 2015).
Fetal CMR is an alternative imaging modality that uses no, ionizing radiation, good tissue contrast and field of view is larger, not limited by maternal obesity or overlying bone and ability of scanning the fetus in different planes, whatever the fetal lie. Fast imaging technique allows study to be performed without sedation especially in second and third trimesters with minimal motion artifact. Till now, it has not been reported that MRI has adverse effects on fetal growth or development.
The aim of our study is to compare accuracy of fetal echocardiography and fetal cardiac MRI in diagnosis of congenital cardiac anomalies and correlate results with post-natal findings.
The prospective study performed on 26 pregnant mothers attending radiology department of Ain Shams University Hospital which have been suspected by usual antenatal ultrasound as having cardiac anomalies. The fetal echocardiography and fetal cardiac MRI were performed after taking full detailed history and a consent from each case then the diagnosis by both modalities was correlated to postnatal echocardiography findings.
In our study, standard post-natal evaluation by echocardiography shows higher statistically significant sensitivity in agreement with Fetal MRI (95.5%) compared to Fetal Echo (86.4%) of overall anomalies, with p-value <0.001 HS.
In addition to conclude that MRI was more accurate than fetal echocardiography, it also played a great role in diagnosis of extra cardiac malformation in 13 cases, all are confirmed post-natal.
In conclusion, MR imaging as an adjuvant to fetal echocardiography may provide valuable information that could add to the prenatal diagnosis and evaluation of cardiac and most of extra cardiac anomalies.
Limitations:
• small sample size.
• Until now fetal CMR has been limited due to technical challenges mainly the lack of a fetal ECG for gating. As a consequence of unavailable direct fetal cardiac gating so far, dynamic fetal CMR was dependent on complicated post-processing techniques only available in a few centres.
Strength of study:
To our knowledge there are no, many previous studies discussed the comparison between fetal echocardiography and MRI in assessment of congenital cardiac anomalies.
Clinical implication:
Fetal cardiac MR is a complementary imaging modality that uses no, ionizing radiation, good tissue contrast and field of view is larger, not limited by maternal obesity or overlying bone and ability of scanning the fetus in different planes, whatever the fetal lie. It provides additional information that improve post-natal follow up and management.
Recommendation:
We recommend further studies with larger sample size to be compared with our study.
MRI can be applied in conjugation with fetal echo may help plan for delivery and neonatal treatment.