EP07.08: Markers and intelligent agent driven early fetal echocardiography in lieu of the conventional views‐focused scanning method

Abstract

To improve the congenital heart disease CHD screening process using dimensionality reduction in the identification of the 26 most common CHDs starting at 11-14week scan. Extracting features from a time-oriented, international registry of prenatal CHDs augmented with cases from the literature, we developed: 1) a database of the natural history of 26 types of CHDs with 112 possible morphologic and biometric markers 2) an Intelligent Agent using markers stratified by a) temporal natural history of the markers b) the strength of association (relevance) of each marker with any other marker across all the CHDs. The database was mostly focused on CHD identification in early gestation and data was obtained primarily by transvaginal sonography. A total of 56 markers fulfilled the diagnostic requirements for 26 CHDs and respectively 48 for 22 CHDs and 42 for 18 CHDs benefiting the most from intrauterine detection. When the first scan is performed by 14wks, the number of subsequent markers participating at the process at any GA was small thanks to constant agent weighing of requirements of markers to be evaluated by comparing strongly relevant features with weakly relevant but not redundant features versus weakly relevant and redundant features and irrelevant features. The result is a significantly reduced diagnostic requirement achievable by sonologists compared with the conventional views based effort. Markers and Intelligent Agent driven fetal cardiac screening allows focusing echocardiography on the most important combination of parameters targeting the earliest and most efficient diagnostic process of CHDs with the minimum effort. Conventional cardiac screening requires the sonologist to capture large amounts of information that may be irrelevant. Mathematically driven scanning includes dynamic instructions streamlining the acquisition of certain views when the yield is low. The use of TVS by 14 wks has the collateral benefit of a significantly reduced, targeted effort at the fetal echo at 18 to 20 wks.

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