Fetal Cardiology

Background

  • Congenital heart disease is the most common birth defect and the leading cause of infant mortality related to birth defects in the U.S.
  • The prenatal diagnosis of congenital heart disease improves the likelihood of survival and reduces morbidity; however, the overall prenatal detection rate for this condition is still poor.
  • Anatomical defects of the fetal heart are difficult to diagnose given the complex structure of the organ, its small size, and cardiac motion.

About the Research Program

  • Anatomic and functional evaluation of the fetal heart in normal and high-risk pregnancies by using unique and advanced sonographic techniques (e.g. four-dimensional ultrasound with spatiotemporal image correlation technology (STIC), tissue Doppler)
  • Leading expertise in the diagnosis of congenital heart disease and functional evaluation of the fetal heart
  • Strong clinical component–performance of fetal echocardiography on pregnant women at our institution and on those referred for evaluation of congenital heart disease from other practices and institutions in the surrounding area
  • Collaboration with pediatric cardiologists of the Wayne State University School of Medicine and Children’s Hospital of Michigan
  • Participation in training of Maternal-Fetal Medicine Fellows and Research Associates at the Perinatology Research Branch

Objectives

  • To study the normal and abnormal fetal heart (anatomic and functional evaluation)
  • To improve the prenatal assessment and diagnosis of congenital heart defects
  • To develop algorithms and techniques to allow trained clinicians to generate the key views to examine the fetal heart after acquiring sonographic volume datasets

Highlights

  • First description of the use of four-dimensional ultrasound with STIC to examine the fetal heart
  • Use of STIC combined with novel technologies to improve assessment of the normal and abnormal fetal heart (Figures 1, 2, 3)
  • Development of novel fetal cardiac algorithms to allow efficient generation of the standard fetal cardiac views required to diagnose most congenital heart diseases:
    • STIC combined with tomographic ultrasound imaging
    • STAR (Simple Targeted Arterial Rendering) technique (Figure 4)
    • FAST (Four-chamber view and Swing Technique) echo
  • Use of color and power Doppler STIC for clinical and research applications (Figure 5)
  • Development of novel techniques to estimate fetal cardiac ventricular volume and fetal cardiac function (e.g. cardiac output, stroke volume) (Figure 6)
  • Development of intelligent navigation technology, a new method to interrogate volume datasets, whereby the system generates a geometrical reconstruction of the organ of interest and then automatically navigates, finds, extracts, and displays specific diagnostic planes
  • Development of Fetal Intelligent Navigation Echocardiography (FINE) – a novel sonographic method that allows automatic generation and display of nine standard fetal cardiac views in normal and abnormal hearts (Figure 7). Scientific investigation has shown that:
    • FINE improves assessment of the normal and abnormal fetal heart
    • Nine standard fetal cardiac views can be automatically generated in 96-100% of normal fetal heart cases
    • FINE detects congenital heart disease in utero with 98% sensitivity and, therefore, is a prenatal cardiac screening and diagnostic tool for congenital heart disease in the clinical setting
  • Development of FINE combined with color and power Doppler velocimetry (Color Doppler FINE), which provides clinically useful information about cardiac structure and function in both normal and abnormal fetal hearts (Figure 8)
  • Successful integration worldwide of FINE and color Doppler FINE into commercially available ultrasound systems (known as 5D Heart and 5D Heart Color)
  • Recent development of eight new and advanced features for the FINE method

Selected Publications

  • Yeo L, Romero R. New and advanced features of fetal intelligent navigation echocardiography (FINE) or 5D Heart. J Matern Fetal Neonatal Med 2020 May:1-19 (online ahead of print)
  • Yeo L, Luewan S, Romero R. Fetal intelligent navigation echocardiography (FINE) detects 98% of congenital heart disease. J Ultrasound Med 2018; 37:2577-2593.
  • Yeo L, Romero R. Color and power Doppler combined with Fetal Intelligent Navigation Echocardiography (FINE) to evaluate the fetal heart. Ultrasound Obstet Gynecol 2017; 50:476-491.
  • Yeo L, Romero R. Fetal Intelligent Navigation Echocardiography (FINE): a novel method for rapid, simple, and automatic examination of the fetal heart. Ultrasound Obstet Gynecol 2013; 42:268-284
  • Yeo L, Romero R, Jodicke C, Ogge G, Lee W, Kusanovic JP, Vaisbuch E, Hassan S. Four-chamber view and “swing technique” (FAST) echo: a novel and simple algorithm to visualize standard fetal echocardiographic planes. Ultrasound Obstet Gynecol 2011; 37:423-431.

Covers of Scientific Journals

  • Ultrasound in Obstetrics and Gynecology (2017): Color and power Doppler combined with Fetal Intelligent Navigation Echocardiography (FINE) to evaluate the fetal heart (Figure 8)
  • Ultrasound in Obstetrics and Gynecology (2013): Fetal Intelligent Navigation Echocardiography (FINE): a novel method for rapid, simple, and automatic examination of the fetal heart (Figure 7)
  • Ultrasound in Obstetrics and Gynecology (2010): The “starfish” sign – a novel sonographic finding with B-flow imaging and spatiotemporal image correlation in a fetus with total anomalous pulmonary venous return (Figure 3)
  • Ultrasound in Obstetrics and Gynecology (2005): A novel method to improve prenatal diagnosis of abnormal systemic venous connections using three- and four-dimensional ultrasonography and inversion mode (Figure 2)
  • Ultrasound in Obstetrics and Gynecology (2004): Three- and four-dimensional reconstruction of the aortic and ductal arches using inversion mode: a new rendering algorithm for visualization of fluid-filled anatomical structures (Figure 1)
  • Journal of Ultrasound in Medicine (2004): Four-dimensional ultrasonography of the fetal heart using color Doppler spatiotemporal image correlation (Figure 5)

Figures

 
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Distinguished Faculty

 

DIRECTOR
Lami Yeo, M.D., F.A.C.O.G., F.A.I.U.M.

Section Head of Fetal Cardiology, Perinatology Research Branch, NICHD/NIH/DHHS
Director, DMC/WSU/PRB Maternal-Fetal Medicine Fellowship Program

FULL BIO