Vol. 12 • No. 46 (4/2016) 190 Early ultrasound evaluation for fetal cardiovascular congenital abnormalities Costin Berceanu 1 , Elvira Brătilă 2 , Sabina Berceanu 1 , Ioana Andreea Gheonea 3 , Monica M. Cîrstoiu 2 , Claudia Mehedințu 2 , Răzvan Ciortea 4 , Octavian Munteanu 5 , Roxana Bohâlţea 5 , Irina Horhoianu 5 , Simona Vlădăreanu 2 1. Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, Romania 2. Department of Obstetrics, Gynecology and Neonatology, ”Carol Davila” University of Medicine and Pharmacy Bucharest, Romania 3. Department of Radiology and Imaging, University of Medicine and Pharmacy of Craiova, Romania 4. Department of Obstetrics and Gynecology, ”Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, Romania 5. Department of Obstetrics and Gynecology, Bucharest Emergency University Hospital, Romania Correspondence: Dr. Elvira Brătilă e-mail: elvirabarbulea@ gmail.com The spectacular evolution of the ultrasound equipment and techniques has allowed the assessment of the fetal heart increasingly earlier during the gestation, as well as the diagnosis of the fetal abnormalities in the first trimester of pregnancy. Transvaginal ultrasound and transabdominal ultrasound are used in early fetal echocardigraphy. Studies have shown that the heart defects diagnosed early in gestation are more complex and have a high degree of association with chromosomal abnormalities, compared to those diagnosed in the second trimester of pregnancy. There are many studies on the correlation between the increase in the nuchal translucency (NT) and congenital heart defects, NT being one of the most frequently studied and efficient screening parameters in maternal-fetal medicine. The morphology of the umbilical cord can be assessed in the first trimester of pregnancy by colour Doppler examination. Numerous anomalies associated with single umbilical artery are described. The principles of fetal echocardiography in the first trimester are similar to those of the morphological examination in the second trimester of pregnancy, with certain peculiarities and differences. The complete examination of the fetal heart, with minimal false results, can be done under the conditions of a trained and experienced examiner within the range of 12-13 gestational weeks. The examination route must be adapted to the particularities of the case. Early fetal echocardigraphy should be recommended only in the presence of a precise medical indication. Keywords: fetal echocardigraphy, first trimester, Doppler, single umbilical artery, heart defects Abstract Received: September 05, 2016 Revised: October 12, 2016 Accepted: October 27, 2016 Gineco.eu [12] 190-197 [2016] DOI: 10.18643/gieu.2016.190 @ 2016 Romanian Society of Ultrasonography in Obstetrics and Gynecology Introduction Congenital heart defects are the group of severe con- genital malformations, the most frequent ones affecting 0.8-1% of newborns (1,2) . Approximately half of them can be considered severe heart malformations (2-4) . The purpose of this paper is to systematically present the key elements of the fetal ultrasound examination in the first trimester of pregnancy, through comprehensive review of the literature and from the authors’ imaging perspective. The risk of association of fetal heart defects with chro- mosomal abnormalities ranges between 15-25% (1,5-9) . Gomez et al. considers that the risk of associating the heart defects with chromosomal anomalies or genetic syndromes is also high and even more significant, if the heart defects are also associated with other structural abnormalities (1) . The first description of a heart abnormality in 11 ges- tational weeks dates since 1990 (3) . The spectacular evolution of the ultrasound equipment and techniques has allowed the assessment of the fetal heart increasingly earlier during the gestation, as well as the diagnosis of the fetal abnormalities in the first trimester of pregnancy. The unanimous adoption of first trimester screening by nuchal translucency (NT) and other key markers led to the increase in the interest and enhancement of the fetal medical research and practice in the field of early fetal echocardiography. The NT screening for the detection of chromosomal abnormalities is a key factor in the development of the fetal echocardiography in the first trimester of pregnancy for at least two reasons: association of chromosomal abnormalities with fetal heart defects and the association between the increased NT and the risk of identifying a heart abnormality (10-16) . The structural abnormalities detected in one or several organs or systems increase the risk of identifying cardiac abnormalities on the one hand and the incidence of chro- mosomal abnormalities on the other hand (2,17-19) . Most of the fetal heart defects (>90%) occur yet preg- nancies without any significant history or associated risk factors (2) . Early Fetal Echocardiography There are many opinions on clearly defining this exa- mination in the first trimester of pregnancy or early during the second trimester of pregnancy (17-20) . Without essential differences, but only in the perspective of the maternal-fetal medicine schools where they come from, they are summarised in Table 1. Examination route Transvaginal ultrasound (TVUS) and transabdominal ul- trasound (TAUS) are used in early fetal echocardigraphy. It is widely recognised both that the transvaginal route provides superior resolution and high image quality, as well as that depending on the particularities of each case, they can be used either selectively, or complementarily (Table 2) (1,2,6,8,14,16) .