15 th World Congress on Ultrasound in Obstetrics and Gynecology Poster abstracts and shown post-natally to be concordant in 2 cases and discordant in the other. Full SSA allowed correct perinatal management for all cases including planned early neonatal assessment for the rare occasions where prenatal uncertainties remained. Conclusions: In the fetus as in the child SSA can be used accurately to describe complex cardiac defects and should be used routinely by the fetal echocardiographer. This approach avoids important omissions in diagnosis and allows optimization of prenatal counseling and perinatal management. P05.08 Technique of visualisation of a new cardiac marker for trisomy 21: the linear insertion of the atrioventricular valves (LIAVV) without defect J. E. Develay-Morice 1 , C. Fredouille 2 , M. Duyme 3 , N. Frandji-Barbier 4 , P. Mar` es 5 1 Maternit´ e, France, 2 CHU Timone, Marseille, France, 3 Universit´ e Montpellier 1, France, 4 CFEF, France, 5 Maternit´ e, CHU Nˆ ımes, France In two previous anatomical studies published about 52 and 213 hearts of trisomic 21 fetuses, we described a new cardiac marker. In 66% of hearts without defect, we found a linear insertion of the atrioventricular valves (LIAVV) instead of the normal offsetting, on a section on the standard foetal four chamber view plane, defined by apex and two inferior pulmonary veins. The goal of our study is to correlate these anatomical findings to ultrasound screening, by a new technique able to emphasize the oblique part between the two septal leaflets, responsible of the normal offsetting. Histological examination of the normal crux of the heart shows an oblique continuity between the two mitral and tricuspid septal leaflets. In case of pathology, this continuity is linear, even without defect. Made quite only with parallel collagen fibres which act like a mirror with ultrasound (US) this oblique portion is hyperechogenic, angle dependent with the US. In the contrary, the interventricular septum made of muscular fibres, less concentrated and parallel, is less echogenic and angle dependent. Appropriate US settings increase the differences. We described the different ways to obtain a perpendicular US incidence on the oblique fibrous portion according to the different positions of the foetus. Of the different settings tried on 2nd and 3rd trimesters foetuses examined (more than 5000): low dynamics appears the main interesting one, more than persistence. Our study allowed us to check systematically the normal offsetting on normal foetuses. After one case of trisomy 21 found because of a LIAVV with no other marker, we induced a large protocol with the French College of Fetal Ultrasonography about this new marker. P05.09 Technique of fetal axial cardiac screening index (CSI) for generalists with or without three-dimensional equipment D. Jackson Fetal Diagnostic Center, USA Objective: Our goal today is to present a simple method of fetal heart examination within the grasp of all sonographers. The application of published individual components of segmental axial imaging produces a ‘‘cardiac screening index’’ (CSI) of fetal cardiac anatomy. It requires no expertise other than obtaining an abdominal circumference orientation followed by motioning the transducer upward towards the fetal mediastinum. Methods: An ongoing literature review allowed us to identify 30 components of a cardiac screen to be routinely identified in five axial planes (AC view, 4-chamber view, LVOT, RVOT and transverse outflow tract). Beginning the angled ‘‘sweep’’ at the abdominal circumference towards the mediastinum corrects for fetal flexion. Aloka and Voluson series equipped with Biomedicom SonoReal systems were utilized to determine the best order of recording these axial variables in a checklist with clinical implications. Results: Over 2000 acquisitions from 400 patients occurred (gestational age from 14–39 weeks). Defects of cardiac size, VSD, hypoplastic left heart, ventricular diverticulum, rhabdomyoma, univentricular heart, tetralogy, and transposition were identified with the CSI. Abnormal cardiac axis was identified in diaphragmatic hernia, hydrops, and bladder obstruction. Suboptimal visualization for the 30 variables gives sonographers a chance to focus their exams. Two patients with subsequent ASD and one patient with aortic coarctation were missed. Additional variables to identify ASD have been added since that point. Acquisition and segmental analysis by checklist occurs in less than 3 minutes, making this a feasible tool for non-cardiac specialists. Conclusions: Current literature allows for rapid segmental analysis of the fetal cardiac axis in the transverse axial plane. Beginning the angled ‘‘sweep’’ at the AC rather than the cardiac level allows 4-chamber and outflow track visualization for generalists as well as targeted ultrasound experts. P05.10 Prenatal diagnosis of congenital heart diseases using STIC Telemedicine (TELE-STIC) via internet link. Preliminary results of 7 centers F. Vinals 1 , P. Poblete 2 , L. Mandujano 3 , G. Vargas 4 , L. Medina 5 , X. Flores 6 , R. Ascenzo 7 , C. Comas 8 , A. Giuliano 1 1 Centro Agb. Clinica Sanatorio Aleman, Chile, 2 Rancagua, Chile, 3 Punta Arenas, Chile, 4 La Serena, Chile, 5 Cedip, Chile, 6 San Felipe, Chile, 7 Lima, Peru, 8 Centro Gutenberg, Malaga, Spain Objective: To asses whether STIC volumes datasets acquired in a standard technique, by operators of different experience in fetal echocardiography, from different centers and different countries can be transmitted over the Internet; and whether offline analysis at a remote center can be used to confirm or exclude cardiac defects(CHD). Method: This was a prospective study involving 140 pregnant women (gestational age 18–37 weeks), from 5 different centers from Chile and others 2 from Lima, Peru and Malaga, Spain. Two of them were tertiary referrals centers. The patients were randomly selected, including patients with extracardiac anomalies, suspected or confirmed CHD uploaded to the dedicated web disk for second opinion. A standard acquisition at the level of the four-chamber view, orthogonal to the fetal body axis were used. Three operators have color Doppler STIC ultrasound machine. Offline analysis was performed by a single investigator. Results: A telemedicine link (TELE-STIC) via Internet was possible in all cases. A complete cardiac examination according to a previously reported set criteria was achieved in 89% of the cases. Thirty patients had CHD and 12/140 extracardiac anomalies, sent to get an opinion about the fetal heart. Fifteen of the 30 CHD were sent from expert centers and the remainder for suspected CHD to be confirmed and to programme perinatal management. Labelled images and clips obtained from the original volume dataset were send back to illustrate the CHD. Conclusion: TELE-STIC was technically feasible. The analysis of the volumes dataset enable recognition of most of the structures and views necessary to asses the fetal heart anatomy. We believe that shortly the number of CHD allow us to evaluate the repeatability of the offline analysis. TELE-STIC permit a second opinion and in some cases modified the perinatal management. Also generate a link between different centers resultant in a new virtual tool for teaching and training in fetal heart. 412 Ultrasound in Obstetrics & Gynecology 2005; 26: 376–471