Echocardiographic Methods of Fetal Heart Size Assessmentheart to Chest Area Ratio and Transversal Heart Diameter

Oskar Sylwestrzak 1  und Maria Respondek-Liberska 2 , 3
  • 1 Medical University of Lodz, 3th Grade, Student Science Club "Prenatal Cardiology", , Lodz, Poland
  • 2 Department of Diagnosis and Prophylaxis of Congenital Malformations of Medical University of , Lodz, Poland
  • 3 Department of Prenatal Cardiology of Polish Mother’s Memorial Hospital Research Institute in , Lodz, Poland


Introduction: Ultrasound assessment of fetal heart size (FHS) is widely used and recommended in many guidelines of fetal echocardiography due to its clinical value. The aim of this study was an analysis of some fetal heart measurements: ratio of heart area to chest area (HA/ CA) and transversal diameter of heart (AP) and their correlation to gestational age.

Material and methods: This retrospective study was based on database of records of ultrasound and echocardiographic examinations performed in our unit and included fetuses between 15th and 39th week of gestation with no evidence of heart defect or any abnormality.

Results: 609 ultrasound examinations were analyzed. The mean HA/CA was 0,30 ± 0,015, with no statistical difference between female and male (p>0,05), and seemed to be relatively constant with slight increase with advancing gestational age. The AP diameter in whole group correlated with gestational age (r=0,94) and there was no difference related to the fetuses gender.

Conclusion: The correlation of AP diameter and relative constancy of HA/CA ratio with gestational age presented in our normograms could be used for monitoring fetal development, but also for fetal cardiomegaly assessment.

Falls das inline PDF nicht korrekt dargestellt ist, können Sie das PDF hier herunterladen.

  • 1. Respondek-Liberska M, Sklansky M, Wood D, Slodki M, Weiner S, Cuneo B, Huhta C.J, Gembruch U, Rizzo G, Sharland G, Achiron R, Pruetz J.D.: Recommendations for fetal echocardiography in singleton pregnancy in 2015. Prenat Cardio. 2015; 5(2): 28-34

  • 2. Satomi G. Guidelines for fetal echocardiography. Pediatr Int. 2015; 57(1): 1-21.

  • 3. American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of fetal echocardiography. J Ultrasound Med. 2013; 32(6): 1067-82.

  • 4. Strzelecka I, Słodki M, Płużańska J, Moszura T, Węgrzynowski J, Respondek-Liberska M. Routine third trimester fetal cardiac evaluation: time for consideration. Prenat Cardio. 2015; 5(3): 18-23.

  • 5. Gembruch U, Shi C, Smrcek JM. Biometry of the fetal heart between 10 and 17 weeks of gestation. Fetal Diagn Ther. 2000; 15(1): 20-31.

  • 6. Respondek M, Respondek A, Huhta J.C., Wilczynski J. 2D echocardiographic assessment of fetal heart size in the 2nd and 3rd trimester of uncomplicated pregnancy. Eur J Obstet Gynecol Reprod Biol. 1992; 44(3): 185-8.

  • 7. Paladini D, Chita SK, Allan LD. Prenatal measurement of cardiothoracic ratioin evaluation of heart disease. Arch Dis Child. 1990; 65: 20-3.

  • 8. Huhta JC, Diagnosis and treatment of foetal heartfailure: foetalechocardiography and foetal hydrops. Cardiol Young. 2015 Aug;25 Suppl 2:100-6.

  • 9. Davey B, Szwast A, Rychlik J. Diagnosis and management of heart failurein the fetus. Minerva pediatrica. 2012; 64(5): 471-492

  • 10. Thakur V, Fouron JC, Mertens L, Jaeggi ET. Diagnosis and management of fetal heart failure. Can J Cardiol. 2013; 29(7): 759-67.

  • 11. Firpo C, Hoffman JI, Silverman NH. Evaluation of fetal heart dimensions from 12 weeks to term. Am J Cardiol. 2001; 87(5): 594-600.

  • 12. Słodki M, Janiak K, Szaflik K, Wilczyński J, Oszukowski P, Chilarski A, Respondek-Liberska M. [Fetal echocardiography in fetal ovarian cysts]. Ginekol Pol. 2008; 79(5): 347-51.

  • 13. Słodki M, Respondek-Liberska M. New classifications of prenatally diagnosed congenital heart defects and their influence of neonatal survivability. Prenat Cardio. 2015; 5(3): 6-8.

  • 14. Slodki, M, Janiak, K, Zarkowska A, Forys S, Respondek-Liberska M. P04.06: Cardiomegaly in fetus: a powerful indicator of fetal and neonatal demise. Ultrasound Obstet Gynecol. 2009; 34:192.

  • 15. Garrett WJ, Robinson DE. Fetal heart size measured in vivo by ultrasound. Pediatrics. 1970; 46(1): 25-7.

  • 16. Devore GR. Three-dimensional and four-dimensional fetal echocardiography: a new frontier. Curr Opin Pediatr. 2005;17(5): 592-604.

  • 17. Dolk H, Loane M, Garne E; European Surveillance of Congenital Anomalies (EUROCAT) Working Group. Congenital heart defects in Europe: prevalence and perinatal mortality, 2000 to 2005. Circulation. 2011; 123(8): 841-9.

  • 18. Leirgul E, Fomina T, Brodwall K, Greve G, Holmstrøm H, Vollset SE, Tell GS, Øyen N. Birth prevalence of congenital heart defects in Norway 1994-2009-a nationwide study. Am Heart J. 2014; 168(6): 956-64.

  • 19. van der Linde D, Konings EE, Slager MA, Witsenburg M, Helbing WA, Takkenberg JJ, Roos-Hesselink JW. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol. 2011; 58(21): 2241-7.

  • 20. Zhang Y, Riehle-Colarusso T, Correa A, Li S, Feng X, Gindler J, Lin H, WebbC, Li W, Trines J, Berry RJ, Yeung L, Luo Y, Jiang M, Chen H, Sun X, Li Z Observed prevalence of congenital heart defects from a surveillance study in China. JUltrasound Med. 2011; 30(7): 989-95.

  • 21. Tegnander E, Williams W, Johansen OJ, Blaas HG, Eik-Nes SH. Prenatal detection of heart defects in a non-selected population of 30,149 fetuses--detection rates and outcome. Ultrasound Obstet Gynecol. 2006; 27(3): 252-65.

  • 22. Persico N, Moratalla J, Lombardi CM, Zidere V, Allan L, Nicolaides KH. Fetal echocardiography at 11-13 weeks by transabdominal high-frequency ultrasound. Ultrasound Obstet Gynecol. 2011; 37(3): 296-301.

  • 23. Respondek-Liberska M, Sokołowski Ł, Słodki M, Zych-Krekora K, Strzelecka I, Krekora M, Maroszyńska I, Moll J, Moll J. Prenatal diagnosis of TAPVC on Monday, delivery of Tuesday and cardiac surgery at Wensday - a model of perinatal care in 3rd trimester in case of fetal/neonatal critical heart defect in tertiary center. Prenat Cardio. 2016; 6(1):37-42

  • 24. Słodki M, Respondek Liberska M. Hypoplastic left heart syndrome at the tertiary fetal cardiac center: as planned, urgent or severest congenital heart disease? Prenatal classification for obstetricians and neonatologists. Prenat Cardio. 2013; 3(4): 23-27.

  • 25. Mäkikallio K, Räsänen J, Mäkikallio T, Vuolteenaho O, Huhta JC. Human fetal cardiovascular profile score and neonatal outcome in intrauterine growth restriction. Ultrasound Obstet Gynecol. 2008; 31(1): 48-54.

  • 26. Sueters M, Middeldorp JM, Vandenbussche FP, Teunissen KA, Lopriore E, Kanhai HH, Le Cessie S, Oepkes D. The effect of fetoscopic laser therapy on fetal cardiac size in twin-twin transfusion syndrome. Ultrasound Obstet Gynecol. 2008; 31(2): 158-63.


Zeitschrift + Hefte