About the Program

Congenital heart disease (CHD) is the most common birth defect, and the leading cause of infant morbidity and mortality related to birth defects. In 2013, hospital costs exceeded $6 billion to care for children with CHD. All pregnancies should undergo prenatal sonographic screening for cardiac defects, since up to 90% of cases occur in the absence of high-risk features. Moreover, studies have shown that the prenatal diagnosis of specific cardiac anomalies improves the pre-surgical condition and mortality rate, survival after surgery, as well as long-term neurocognitive function and outcome.

Unfortunately, the overall prenatal detection rate for congenital heart disease via ultrasound still remains poor. This is due to various factors, such as the complex anatomy and small size of the fetal heart, as well as the high level of expertise and skill required to evaluate this organ. Therefore, to address these issues, the PRB successfully developed a novel method known as Fetal Intelligent Navigation Echocardiography (FINE) to interrogate fetal sonographic cardiac volume datasets using intelligent navigation technology. This allows the automatic display of nine standard fetal cardiac views required to diagnose most cardiac defects. The FINE method considerably simplifies examination of the fetal heart and reduces operator dependency. Indeed, FINE has already been licensed and successfully integrated worldwide into several commercially available ultrasound systems, and is known as 5D Heart.

Recently, the FINE method has been shown to have high sensitivity (98%) and specificity (93%) for the detection of CHD. Thus, FINE offers a novel clinical solution to bring high quality prenatal screening and diagnosis of CHD to all pregnant women. This year, the PRB has developed eight new and advanced features of FINE to further improve the technology for physicians and pregnant women in their care.

The Fetal Cardiology Program also provides leading expertise in the diagnosis of congenital heart disease and functional evaluation of the fetal heart.

Objectives

To investigate the fetal heart in normal and high-risk pregnancies (anatomic and functional evaluation) by using advanced sonographic techniques (e.g. four-dimensional ultrasound, tissue Doppler)
To improve the prenatal assessment and diagnosis of congenital heart disease
To develop four-dimensional sonographic algorithms and techniques to allow trained clinicians to generate key cardiac views to examine the fetal heart
To provide a strong clinical component – the Program performs fetal echocardiography on pregnant women at our institution, as well as those referred from other practices and institutions in the surrounding area
To train Maternal-Fetal Medicine Fellows and other health care providers in fetal cardiology

Power Doppler combined with STIC technology

Normal crisscrossing of great vessels

Transposition of great vessels

Goncalves LF et al. J Ultrasound Med 2004; 1225

Research Highlights

Developed Fetal Intelligent Navigation Echocardiography (FINE) – a novel sonographic method that automatically generates and displays nine standard fetal cardiac views in normal hearts (96-100% of cases) and abnormal hearts
Developed intelligent navigation technology, a new method to interrogate volume datasets (e.g. ultrasound) whereby the system generates a geometric reconstruction of the organ of interest and then automatically navigates, finds, extracts, and displays specific diagnostic planes
FINE detects congenital heart disease in-utero with 98% sensitivity and 93% specificity
Recently developed eight new and advanced features of the FINE method
Developed Color Doppler FINE (FINE combined with color and power Doppler velocimetry) which provides clinically useful information about cardiac structure and function in both normal and abnormal fetal hearts
FINE and Color Doppler FINE have been licensed and successfully integrated worldwide into several commercially available ultrasound systems (known as 5D Heart and 5D Heart Color, respectively)
Developed novel fetal cardiac algorithms to allow efficient generation of the standard fetal cardiac views required to diagnose most congenital heart defects
- STAR (Simple Targeted Arterial Rendering) algorithm
- FAST (Four-chamber view And Swing Technique) Echo algorithm
- Spatiotemporal image correlation (STIC) combined with tomographic ultrasound imaging
Developed novel techniques to estimate fetal cardiac ventricular volume and fetal cardiac function (e.g. cardiac output, stroke volume)
Demonstrated the value of STIC combined with color and power Doppler velocimetry in both clinical and research applications
Demonstrated the value of STIC combined with other imaging applications (e.g. inversion mode) to improve assessment of the normal and abnormal fetal heart
First description of the use of four-dimensional ultrasound with STIC to examine the fetal heart

Select Publications, Journal Covers, Educational Material

Cardiac measurements of size and shape in fetuses with absent or reversed end-diastolic velocity of the umbilical artery and perinatal survival and severe growth restriction before 34 weeks’ gestation. DeVore GR, Portella PP, Andrade EH, Yeo L, Romero R. J Ultrasound Med 2020 October (online ahead of print).
New and advanced features of fetal intelligent navigation echocardiography (FINE) or 5D Heart. Yeo L, Romero R. J Matern Fetal Neonatal Med 2020 May:1-19.
Fetal intelligent navigation echocardiography (FINE) detects 98% of congenital heart disease. Yeo L, Luewan S, Romero R. J Ultrasound Med 2018;37:2577-2593.
Color and power Doppler combined with fetal intelligent navigation echocardiography (FINE) to evaluate the fetal heart. Yeo L, Romero R. Ultrasound Obstet Gynecol 2017;50:476-491.
Fetal intelligent navigation echocardiography (FINE): a novel method for rapid, simple, and automatic examination of the fetal heart. Yeo L, Romero R. Ultrasound Obstet Gynecol 2013;42:268-284.

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)