Early Echocardiography
Echocardiography (diagnostic of the heart) as part of the ETS allows an experienced examiner to rule out up to 80% of the vitien (heart defects) in the first 14 weeks of pregnancy, which is alredy remarkable for 8-10mm heart sizes at this point. A prerequisite is a representation of all levels and connectivities with the corresponding sectional planes, as well as the Doppler examination, in particular of the DV as preload of the heart and the blood flow over the tricuspid cap.
All examinations in the first trimester, which are listed in advance, are in most cases still IGEL services at the current time.
2nd and 3rd trimester
An essential part of malformation ultrasound/ differential organ diagnosis in the second trimester is fetal echocardiography (ultrasound of the heart and Doppler). The success of this examination of the child’s heart and the large and small arteries and veins (blood vessels) depends on how qualified and experienced the examiner is. A specialist in this field, as Dr. Achenbach can, under optimal conditions, recognize or rule out a large part (up to 80%) of fetal heart defects (vitien) between the 13th and 15th week of pregnancy. However, there are also heart defects that re not yet recognizable in the 20th/21st week of pregnancy or only under extremely good sound conditions such as a very slim abdominal wall, little sound-absorbing and ideal child position. This includes narrowing of the heart valves and vessels, the consequences of which can only be seen later. In individual cases, these can be so marginal and well compensated be the fetal heart that they only become noticeable after birth, when the fetal blood circulation changes. Then e.g. due to the physiological occlusion of the short-circuit connection still present in the womb, pressure gradients that lead to restrictions with small defects that can only be recognized on ultrasound, day to week after birth. So e.g. with very small holes (atrial or ventricular septal defects) in the dividing wall of the heart chambers or atria. These occur in up to 4% of pregnancies, often only intermittently. Many of these small muscle gaps close up until birth, and the majority of those identified at birth still need 1-2 years before spontaneous closure. These defects rarely have to be closed by cardiac surgery. Namely only if they do not close spontaneously and are hemodynamically relevant.
The final assessment of the heart, its function and the blood flow is ideally carried out between the 20th and 22nd week of pregnancy and should usually be completed by the 23rd week of pregnancy. At a later point in time of pregnancy. The diagnosis is often affected by the child’s unfavorable position and the poor sound transmission of the child’s ribs.
As part of echocardiography, we control:
- Location, size and symmetry of the heart
- Anatomy of the heart structure
- Function of the heart valves
- Heartbeat rate
- Contractility of the heart muscles
- Connectivity of arterial and venous vessels
- Blood flow in the heart chambers, the subsequent vessels and over the heart valves
- Exclusion of fetal heart tumors
In the event of findings or suspicion of a heart defect or an aberrant vascular system, targeted advice is given as part of a perinatological consultation with the help of pediatric cardiologists from our cooperation partner clinic. It will be discussed with you where and under what conditions the birth should take place and how the procedure looks after the birth.
By law, a fetal vitium is not a reason for performing a caesarean section.
Most congenital heart defects can be operated on very well these days. The success rate of the treatment demonstrably increases with prenatal discovery- even if this diagnosis can initially cause anxiety in the parents.