The 'in-plane' view of the inter-ventricular septum. A new approach to the characterization of ventricular septal defects in the fetus

Objectives: Objectives of this study are (1) to describe how to obtain the in-plane view of the inter-ventricular septum, (2) to assess its feasibility in a population of fetuses referred for fetal echocardiography, (3) to demonstrate its effectiveness in the characterization of VSD in the fetus. Methods: The in-plane view of the inter-ventricular septum is conducted in a plane almost perpendicular to that of the long axis of the left ventricle, tilting the transducer towards the right ventricle, paying attention not to 'enter' the right ventricular chamber. Its feasibility has been assessed in 41 fetuses referred for fetal echocardiography, by recording the visualization/failure rates by fetal lie and acoustic window. The in-plane view of the inter-ventricular septum was then employed in healthy fetuses and diseased fetuses with VSDs. Results: The success rates in obtaining the in-plane view of the inter-ventricular septum was dependent upon fetal lie; visualization rates were 100, 36 and 0% in case of posterior, lateral and anterior spine, respectively. When used in the anatomic characterization of VSDs, this view provided significant additional information. Conclusions: The in-plane view of the inter-ventricular septum represents a new echocardiographic view that can be used to enhance the assessment of the inter-ventricular septum of the fetal heart. Its use should be considered whenever the presence of a VSD is suspected during fetal echocardiography, and in these cases it often provides additional information.