The left outflow tract in foetal echocardiography screening: an audit of
practices and quality criteria.
Abstract
Background: The detection rate of congenital heart defects is barely
acceptable. Since 2016, the French National Conference on Obstetrical
and Foetal Ultrasound updated its recommendations by the inclusion of an
examination of the left ventricular outflow tract (LVOT) in the second
and third trimester of pregnancy. Objectives: This study aimed on the
one hand to evaluate the practices related to the realization of the
LVOT in the setting of fetal echocardiography in low-risk populations,
and on the other hand to study the possible modifications of the
practices secondary to the introduction of quality criteria. Study
Design: We conducted a multicentric, retrospective and prospective,
descriptive, longitudinal study divided into three distinct periods:
before 2016, in 2017, and in 2020. Seven quality criteria were
investigated and rated from 0 to 1 for LVOT screening. Files were
randomly selected from three centers, then average total and specific
scores were calculated. Results: LVOT images were present in ultrasound
reports in more than 93% of cases. Before 2016, the average quality
score was 5.49/7 (95% CI: 5.36-5.62), in 2017 5.91/7 (95% CI:
5.80-6.03), and in 2020 5.70/7 (95% CI: 5.58-5.82) for the three
centers. There was no significant difference following the introduction
of the quality criteria; 2017 vs. 2020, p = 0.054. Kappa coefficients of
the inter- and intra-operator variables were all within 0.601 and 1.
Conclusion: Left ventricular outflow tract images were present in most
of ultrasound reports. The introduction of the proposed quality criteria
is not associated with a significant change in practice.