Three-dimensional Evaluation of Atrioventricular Valve Geometry in the Fetal Heart: Establishing Reference Standards and Clinical Validation.

Authors

Tassyele Pamplona Nogueira, Gustavo Yanno Callado, Nathalie Jeanne Bravo-Valenzuela, Edward Araujo Júnior

Published in

Journal of cardiovascular echography. Volume 36. Issue 4. Pages 418-424. Epub May 06, 2026.

Abstract

To establish the reference values for the angle between the atrioventricular (AV) valve insertion levels in fetal hearts using three-dimensional ultrasound with Spatio-temporal Image Correlation (STIC) rendering and to validate these values in fetuses with confirmed congenital heart disease (CHD).
A retrospective cross-sectional study was conducted using 59 STIC volumes from structurally normal fetuses between 20 and 33 + 6 weeks of gestation. The AV valve insertion angle was measured in the rendering mode of four-chamber view. A polynomial regression model was used to generate a reference curve and percentile table. A validation cohort of 26 fetuses with CHD was analyzed, and angle distributions were compared with the normative percentiles.
The insertion angle remained stable throughout gestation. Reference percentiles (5^th, 10^th, 50^th, 90^th, and 95^th) were established by gestational week. Among fetuses with CHD, 46.2% had angles below the 5^th percentile and 57.7% above the 95^th percentile, with only 7.7% within the normal range. Specific CHD such as tetralogy of Fallot, transposition of the great arteries, and truncus arteriosus showed consistent deviations from normal values.
The AV valve insertion angle was a stable parameter throughout gestation and demonstrates significant deviation in fetuses with CHD. This measurement may serve as a useful screening tool for early prenatal identification of certain structural CHD.

PMID:
42781645
Bibliographic data and abstract were imported from PubMed on 25 Sep 2026.

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