evaluation of fetal heart
DESCRIPTION
BASICS OF FETAL HEART SCANNINGTRANSCRIPT
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Evaluation of the fetal heart
Rima Bader MD ,PhD Professor of Pediatrics, Pediatric &Perinatal cardiology
King Abdul Aziz University College of medicine
Jeddah, Saudi Arabia
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Theoretical Advantage of Prenatal Diagnosis
• Society
– Reduce unnecessary medical costs (transport)
– Reduce hospital stay (improved preop status)
– Improved outcomes
• Medical Professionals
– Improved understanding of natural history in utero
– Improved counseling
– Makes our job interesting
– More stable patient
– Potential for fetal therapy
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Fetal Echocardiography
Indications
Maternal
Fetal
Familial
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Fetal Echocardiography
Reason for Referral
Among Affected Pregnancies
Suspected
cardiac defect
on OB U/S (75%)
Extracardiac
defect (20%)
Maternal
disease (2%)
Family hx (2%)
Other (1%)
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Fetal Cardiovascular Assessment
Fetal Cardiac Screen
Detailed Fetal Echocardiogram
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Fetal Cardiovascular Assessment
Fetal Echocardiography
• Detailed assessment of cardiovascular anatomy by 2-D imaging
• Assessment of blood flow within the heart, systemic and pulmonary veins, and great arteries
• Assessment of ventricular (systolic & diastolic) function
• Assessment of rhythm
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Fetal Echocardiography: The Normal Anatomy
Components
•Define fetal position including left & right
•Defining Visceral-Atrial Situs
•The 4 Chamber View
•The Outlets, Great Arteries, Arches
•3 Vessel View
•Basic Rhythm and Function
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Abdomen and Four-Chambers
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Checklist of upper abdomen
Liver on right side
Stomach on left side
IVC right to the spine ventral
and right to the aorta
Ao left to the spine
L R
Fetal position
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Ascites/NIHF (20% cardiac)
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IVC
Ao
St.
Situs Inversus Totalis
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Situs Solitus Situs Inversus
Left Isomerism Right Isomerism
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Checklist in Four-Chamber-View I
Size of the heart
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Size of the heart
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Checklist in Four-Chamber-View I
Position of the heart
Size of the heart
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Position of the heart /Shifting
Diaphragmatic hernia
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Diaphragmatic hernia
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Dextroversion
Position of the heart /Heart axis
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Checklist in Four-Chamber-View I
Position of the heart
Size of the heart
Heart axis 45° +- 15°
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Heart axis
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Checklist in Four-Chamber-View I
Position of the heart
Size of the heart
Rhythm and Contractility
Shifting
Pericardial effusion,
hydrothorax
Heart axis 45° +- 15°
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Hydrops!
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RV
LV
LA
RA
Four-Chamber-View
Ao
MV
TV
IAS
IVS
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”NORMAL” 4 chamber view
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Foramen ovale!
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LA
RA
RV
LV
Four-chamber view: The ventricles
Sternum
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L
R
RV LV
Atrioventricular discordance
in corrected TGA
LA RA
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?
No ventricle Hypoplasia
Left ventricle
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RV
LV
„normal“ size Dilated
Left ventricle
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RV
LV
Dilated
Left ventricle
LV
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RV LV
RV
LV
Hypoplastic LV Hypoplastic RV
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Aortic coarctation
Comparison LV/RV width
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Single ventricle!
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”NORMAL” 4 chamber view
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RV
RA
LV
LA
Insertion of AV-valves
Ebstein
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Insertion of AV-valves
AVSD
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AVSD
AV-Valves: Position and Patency
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3 D-AVSD
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RV
LV
LA
RA
Ao
Ao
Five-Chamber-View
Connection of the aorta with the LV
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3 vessel view
SVC
Aorta
PA spine
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Five-Chamber-View
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Size of the ascending aorta
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Override or not override ?
RV LV
Ao
Normal Overriding
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Pulmonary atresia + VSD
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Abnormal 4 chamber view:23
wks! !
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Fetal Echocardiography
Spectral Doppler Assessment
• IVC/SVC
• Pulmonary veins
• Foramen Ovale
• Mitral and Tricuspid valve flows
• Ventricular
outflows/great arteries
• Ductus venosus
• Ductus arteriosus
• Umbilical artery
• Umbilical vein
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Fetal Echo:Functional Assessment
Ventricular Diastolic Function
LV isovolumetric
relaxation time
M
V
Ao
L EFE Cardiomyopathy
<50ms
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NORMAL -1 POINT -2 POINTS Cardiomegaly
(Heart Area /ChestArea)
< 0.35
(2 pts)
0.35 - 0.50
> 0.50
Peripheral Doppler
(Umbilical artery)
UA
(Normal) (2 pts)
UA
(AEDV)
UA
(REDV)
Cardiac Function
Normal TV & MV
RV/LV S.F. > 0.28
Biphasic diastolic filling
(2 pts)
Holosystolic TR or
RV/LV S.F. < 0.28
Holosystolic MR or
TR dP/dt < 600 or
Monophasic filling
Venous Doppler
(Umbilical vein)
(Ductus venosus)
UV
DV
(2 pts)
UV
DV
UV pulsations
Hydrops
None
(2 pts)
Ascites or
Pleural effusion or
Pericardial effusion
Skin edema
Cardiovascular Profile Score (CVP)
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4 chamber view
Function, Rhythm and Anatomy
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Blocked PAC
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37-channel system
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Fetal SVT
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Fetal intervention! AS
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Thank you!