Introduction
Prenatal screening for congenital heart defects (CHD) reduces the
mortality and morbidity of newborns (1)(2), but also helps to improve
their neuro-developmental outcome (3)(4). However, there is room for
improvement in this screening which varies considerably, not only
between countries, but also between regions within countries (5)(6)(7).
According to Sklansky et al. , the main reason for this
shortcoming is that effective foetal echocardiography requires not only
different images specific to the individual, as recommended by the
national (CNEOF) and international (ISUOG, AUIM) learned societies, but
also, and above all, good quality, informative images (8). The quality
of cardiac screening examinations is the cornerstone to improve the
detection rate of CHD in a low-risk population (9).
For more than 20 years, it has been recognized that screening for CHD
can be improved by adding outflow tracts to the images of the four
chamber view, with reported screening rates of 80% compared to 50%
previously (10). After the CNEOF updated factors to be included in
ultrasound screening in France in 2016, examination of the left
ventricular outflow tract (LVOT) was added to ultrasound examination
conducted in the second and third trimester of pregnancy.
The use of quality criteria for outflow tract scans addresses the need
to minimize the source of misevaluation and/or misinterpretation of
images of foetal heart anatomy, for this area of interest (8).
The objective of this study was, on the one hand, to carry out an audit
of past and current practices and, on the other, to study possible
modifications following the introduction of quality criteria for LVOT
examination in the field of foetal echocardiography screening. It is
crucial to rely on precise anatomical features which should be
investigated and identified on such images.