Left ventricular function evaluation of the fetal heart: reference intervals and inter-observer variability of 2D speckle-tracking echocardiography measurements.

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.

Isolated anomalies of the fetal hand - two case reports and a review of the literature.

Fetal ultrasonography remains the main diagnostic tool for the assessment of different malformation. Fetal limb anomalies can be either isolated, either associated with other malformations in context of different syndromes. We present two cases of isolated fetal limb anomalies involving the distal part of the upper limb, namely the fetal hand consisting in phalangeal aplasia detected through routine ultrasound fetal examination. We could not identify the etiology in any of the cases, but in one of them, we discovered a bilateral thumb anomaly of the mother's hand. Both fetuses were aborted spontaneously without any relation to the detected anomaly. The upper limb anomaly was confirmed by the clinical, radiological and anatomopathological examinations of the aborted fetuses. The early detection of fetal limb anomalies provides the opportunity of choosing the best therapeutic management. Genetic counseling must also be taken under consideration for further pregnancies.