Changes in fetal cardiac axis between 8 and 15 weeks' gestation

Authors

  • A. McBrien,

    1. Fetal and Neonatal Cardiology Program, Department of Pediatrics, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
    Search for more papers by this author
  • L. Howley,

    1. Fetal and Neonatal Cardiology Program, Department of Pediatrics, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
    Search for more papers by this author
  • Y. Yamamoto,

    1. Fetal and Neonatal Cardiology Program, Department of Pediatrics, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
    Search for more papers by this author
  • D. Hutchinson,

    1. Fetal and Neonatal Cardiology Program, Department of Pediatrics, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
    Search for more papers by this author
  • A. Hirose,

    1. Fetal and Neonatal Cardiology Program, Department of Pediatrics, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
    Search for more papers by this author
  • P. Sekar,

    1. Fetal and Neonatal Cardiology Program, Department of Pediatrics, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
    Search for more papers by this author
  • V. Jain,

    1. Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada; Women's and Children's Health Research Institute, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
    Search for more papers by this author
  • T. Motan,

    1. Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada; Women's and Children's Health Research Institute, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
    Search for more papers by this author
  • J. Trines,

    1. Fetal and Neonatal Cardiology Program, Department of Pediatrics, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
    Search for more papers by this author
  • W. Savard,

    1. Fetal and Neonatal Cardiology Program, Department of Pediatrics, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
    Search for more papers by this author
  • L. K. Hornberger

    Corresponding author
    1. Fetal and Neonatal Cardiology Program, Department of Pediatrics, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
    2. Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada; Women's and Children's Health Research Institute, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
    • Correspondence to: Dr L. K. Hornberger, Pediatric Cardiology, Stollery Children's Hospital, WMC 4C1.19 8440 - 112 Street, Edmonton, Alberta T6G 2B7, Canada (e-mail: lisa.hornberger@albertahealthservices.ca)

    Search for more papers by this author

ABSTRACT

Objectives

To document changes in the normal embryonic/fetal cardiac axis in the late first and early second trimesters of pregnancy.

Methods

Images from 188 fetal echocardiograms performed prospectively between 8 and 15 weeks' gestation in 166 healthy pregnancies and in 10 pregnancies with severe fetal heart disease were reviewed. For each echocardiogram, three measurements of the cardiac axis were taken in the axial plane at the level of the four-chamber view. Differences in mean embryonic/fetal cardiac axis at different gestational ages in the healthy pregnancies were compared.

Results

The mean ± SD embryonic/fetal cardiac axis was 25.5 ± 11.5° from 8 + 0 to 9 + 6 weeks (Group  1), 40.4 ± 9.2° from 10 + 0 to 11 + 6 weeks (Group  2), 49.2 ± 7.4° from 12 + 0 to 12 + 6 weeks (Group  3), 50.6 ± 5.7° from 13 + 0 to 13 + 6 weeks (Group 4) and 48.6 ± 7.3° from 14 + 0 to 14 + 6 weeks (Group 5). Groups 1 and 2 were significantly different from each other and all other groups (P < 0.05). The results for 22 cases with repeat measurements from 8 + 0 to 11 + 6 and 12 + 0 to 14 + 6 weeks confirmed that the embryonic/fetal cardiac axis increased significantly (P < 0.001). In the cases with severe congenital heart disease, the cardiac axis was > 90th centile in four cases and < 10th centile in two cases.

Conclusions

The embryonic cardiac axis is relatively midline at 8 weeks and levorotates in the late first trimester. By 12 weeks' gestation, the normal leftward fetal cardiac axis is established and remains stable until at least 14 + 6 weeks. Observation of an abnormal cardiac axis in some cases of severe congenital heart disease prior to 15 weeks' gestation may assist in prenatal detection. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.

Ancillary