{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:38:50Z","timestamp":1760060330262,"version":"build-2065373602"},"reference-count":31,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T00:00:00Z","timestamp":1755648000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: First-trimester referral scans in high-risk pregnancies are performed by expert fetal medicine operators using an extended protocol that includes direct fetal heart assessment. This study evaluated inter-operator agreement in characterizing the four-chamber view (4CV) and three vessels and trachea view (3VTV) using color Doppler during such scans in both normal and abnormal cases. Methods: Two independent operators and a fetal cardiologist, all blinded to final diagnoses, retrospectively reviewed 2D images and video clips of the 4CV and 3VTV in 90 fetuses (45 with congenital heart disease [CHD] and 45 controls). The 4CV was classified into four patterns: (1) two atrioventricular (A-V) inflows of similar size, (2) one A-V inflow filling two ventricles, (3) one A-V inflow filling one ventricle, and (4) two A-V inflows with disproportion. The 3VTV was assessed for (1) normal V-sign, (2) abnormal vessel number, (3) abnormal vessel dimension, (4) abnormal spatial relationships, and (5) ductal dependence. Agreement was measured using Cohen\u2019s Kappa. Results: Perfect agreement (K = 1) was seen in normal cases. In CHD cases, inter-operator and operator\u2013cardiologist agreement was almost perfect for 4CV (K = 0.83\u20130.96) and substantial for 3VTV (K = 0.77\u20130.80). The lowest agreement occurred with ventricular disproportion in 4CV and abnormalities in vessel number and size in 3VTV. Conclusions: Expert operators show strong agreement in interpreting 4CV and 3VTV patterns in first-trimester scans using color Doppler. However, certain abnormalities\u2014particularly ventricular disproportion and vessel anomalies\u2014remain challenging to consistently interpret.<\/jats:p>","DOI":"10.3390\/diagnostics15162088","type":"journal-article","created":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T13:18:14Z","timestamp":1755695894000},"page":"2088","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Color Doppler Patterns\u2019 Recognition Indicative of Congenital Heart Defects at the First-Trimester Referral Scan"],"prefix":"10.3390","volume":"15","author":[{"given":"Valentina","family":"De Robertis","sequence":"first","affiliation":[{"name":"Fetal Medicine Unit, Department of Human Reproductive Medicine, 70131 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2109-6182","authenticated-orcid":false,"given":"Mariachiara","family":"Bosco","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Department of Human Reproductive Medicine, 70131 Bari, Italy"},{"name":"Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, AOUI Verona, 37129 Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4340-7225","authenticated-orcid":false,"given":"Ilaria","family":"Fantasia","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Department of Human Reproductive Medicine, 70131 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6558-106X","authenticated-orcid":false,"given":"Claudiana","family":"Olivieri","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Department of Human Reproductive Medicine, 70131 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7630-6514","authenticated-orcid":false,"given":"Tiziana","family":"Fanelli","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Department of Human Reproductive Medicine, 70131 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Volpe","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Department of Human Reproductive Medicine, 70131 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1093\/ije\/dyz009","article-title":"Global birth prevalence of congenital heart defects 1970-2017: Updated systematic review and meta-analysis of 260 studies","volume":"48","author":"Liu","year":"2019","journal-title":"Int. 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