21st World Congress on Ultrasound in Obstetrics and Gynecology Oral poster abstracts OP35.03 Fetal cardiac rhabdomyoma: short-term and long-term outcome K. Lee , H. Won, J. Shim, P. Lee, A. Kim Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea Objectives: Rhabdomyoma is the most common type of cardiac tumor in fetuses and is often associated with tuberous sclerosis complex (TSC) with neurologic sequelae. The purpose of this study is to investigate short-term and long-term outcome of fetal cardiac rhabdomyoma. Methods: We analyzed the clinical characteristics of 23 cases prenatally diagnosed with cardiac rhabomyomas on fetal echocar- diography at Asan Medical Center between January 1998 and December 2009. We performed postnatal workup including brain magnetic resonance imaging (MRI), echocardiography, abdominal ultrasonography and molecular genetic analysis to confirm the pres- ence of cardiac rhabdomyomas associated with or without TSC. Results: Among 23 cases, 17 cases (74%) had available outcome and 6 cases (26%) were lost to follow-up. 1) The survival rate was 100% (17/17). 2) Among 17 cases, while spontaneous tumor regression occurred in 11 cases (65%), no change in tumor size and number was observed in the remaining 6 cases (35%). 3) There was no evidence of long-term cardiac dysfunction due to remnant rhabdomyomas, regardless of tumor size. 4) TSC was revealed in 9 patients (53%), of whom four (44%) showed neurodevelopmental morbidities. 5) Among 4 patients with neurologic impairment, three (75%) had TSC gene (TSC1/TSC2) mutation. 6) Seven (78%) of 9 TSC cases were non-familial. Conclusions: The overall outcome of isolated cardiac rhabdomy- omas was favorable. We suggest that systematic evaluation of TSC be performed even in cases of cardiac rhabdomyomas without family history of TSC. Molecular diagnosis of TSC1 and TSC 2 might be helpful in predicting short-term and long-term neurodevelopmental outcome. OP35.04 1 st trimester detection of congenital heart defects during routine nuchal translucency screening: a prospective study G. R. DeVore , B. Polanco Fetal Diagnostic Center, Pasadena, CA, USA Objectives: Previous studies have reported the association between an increased nuchal translucency (NT) of > 3.5 mm and congenital heart defects (CHD). However, this group of fetuses makes up a small percentage of fetuses undergoing NT screening. The purpose of this study was to determine the detection rate for CHD during 1 st trimester NT screening when using a combination of abdominal and endovaginal ultrasound. Methods: All patients with a singleton pregnancy referred for NT screening between 11 weeks and 14 weeks of gestation underwent both transabdominal and endovaginal ultrasound evaluation of fetal anatomy. B-mode and power Doppler ultrasound (Thermal Index of 0.2 or less) were used to examine the four-chamber and outflow tracts of the fetal heart. Results: The study consisted of 2412 consecutive singleton fetuses. The crown–rump length (CRL) ranged between 4.1 and 9.4 cm (mean 6.5 ± 0.9 SD), and was normally distributed. Fetal cardiac anatomy was imaged in 98% of fetuses. The rate of complex heart defects was 4/1000. Eighty percent of complex heart defects were identified in fetuses with a NT < 3.5 mm. Only 20% (2/10) of fetuses with complex heart defects were identified using the abdominal ultrasound. The following table lists the distribution of findings categorized by the NT measurements. Conclusions: Endovaginal B-mode and power Doppler ultrasound reliably detects congenital heart defects during 1 st trimester NT screening. Therefore, those providing NT screening services should consider incorporating these two imaging modalities to increase the identification of fetuses with CHD. OP35.04: Table 1. Incidence of CHD in fetuses undergoing 1 st trimester NT screening NT measurement Isolated tricuspid regurgitation Abnormal ventricles Abnormal outflow tracts Isolated ventricular septal defect 1.1–1.9 9 – – – < 3.5 mm – 8 2 0 ≥ 3.5 – 2 2 0 OP35.05 Accuracy of antenatal fetal cardiac diagnoses in a tertiary fetal medicine unit R. Parasuraman 1 , Z. Lim 2 , D. T. Howe 1 1 Wessex Fetal Medicine Unit, Southampton University Hospitals, Southampton, United Kingdom; 2 Department of Paediatric Cardiology, Southampton University Hospitals, Southampton, United Kingdom Objectives: The Wessex Maternal and Fetal Medicine Unit (WFMU) provides tertiary services for central South England, covering approximately 28,000 deliveries annually. We wished to examine our accuracy of antenatal diagnosis of fetal cardiac anomalies. Methods: Fetal medicine consultants examine the heart in all anomaly scans including outflows and pulmonary veins. Suspected cardiac anomalies are seen jointly with paediatric cardiologists. We identified all pre or postnatally diagnosed cardiac anomalies from deliveries in 2008 and 2009 on the regional congenital anomaly register and then checked if scanned antenatally in our unit. The initial cardiac diagnosis and any modification during pregnancy was noted. We ascertained postnatal diagnoses from the notes of liveborn children and post-mortems after termination. We excluded dysrhythmias and cardiomegaly secondary to arteriovenous malformation or viral infection. Results: There were 223 registered cases of congenital cardiac abnormality. The mothers of 112 were seen antenatally in WFMU. 18% (41/223) had chromosomal abnormalities. Of the 112 fetuses with cardiac anomalies examined in the WFMU the cardiac diagnosis progressed or altered significantly in pregnancy in 8 (7%); there was a significant postnatal change of diagnosis in 3 (3%) and a minor discrepancy in 9 (8%); minor abnormalities were not recognised in 8 (7%) and major abnormalities missed in 4 (4%). In two mothers referred after 28 weeks with polyhydramnios (due to extra-cardiac abnormalities) hindering views, Fallot’s tetralogy was missed. One aortic coarctation and one total anomalous pulmonary venous drainage were not recognised. Conclusions: Accuracy of diagnosing fetal cardiac problems is generally high but a significant proportion of minor abnormalities and a small proportion of major abnormalities may not be identified antenatally. Some lesions will progress in pregnancy altering predicted outcome. Counselling should reflect these limitations, especially when views are difficult. OP35.06 Detection of major fetal heart defects with routine use of colour Doppler C. Heien 1 , M. Berget 3 , C. Lycke Ellingsen 2 , T. M. Eggebø 1 1 Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway; 2 Department of Pathology, Stavanger University Hospital, Stavanger, Norway; 3 Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway Objectives: The use of colour Doppler is recommended when a fetal heart defect is suspected, but routinely use of Doppler remains 156 Ultrasound in Obstetrics & Gynecology 2011; 38 (Suppl. 1): 56–167