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Fetal Echocardiography

Fetal Echocardiography. Dr. Avisa Tabib Pediatric Cardiologist Rajaei Cardiovascular Medical and Research Center. INDICATIONS. Fetal : Abnormal screening obstetric ultrasound. Extracardiac anomalies (omphalocele, duodenal atresia VACTERL,spina bifida )

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Fetal Echocardiography

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  1. Fetal Echocardiography Dr. Avisa Tabib Pediatric Cardiologist Rajaei Cardiovascular Medical and Research Center

  2. INDICATIONS Fetal : • Abnormal screening obstetric ultrasound. • Extracardiac anomalies (omphalocele, duodenal atresia VACTERL,spina bifida ) • Chromosomal abnormalities (trisomies, microdeletion) • Increased first – trimester nuchal translucency • Nonimmune hydrops • Tachyarrhythmias • Bradyarrhythmias

  3. INDICATIONS Maternal: • Diabetes • Phenylketonuria • Teratogen exposure (lithium ,phenytoin, valproic acid • ,carbamazepin,isotretinoin ) • Viral infection during first-trimester

  4. INDICATIONS • Familial : • Previous child with CHD • Paternal congenital heart defect • Tuberous sclerosis • Noonan syndrome • Velocardiofacial syndrome

  5. Assessment of the central cardiovascular connection is electively performed from 18 weeks gestation onwards. How ever , major CHD can also be detected earlier , at 12_ 14 weeks , in high-risk cases Timing of Examination

  6. Axial views 4-chamber view 3-vessel view Oblique views long axis of the LV long axis of the RV short axis of the RV Sagittal views cavo- atrial junction aortic arch ductal arch Ultrasound approach and scanning planes

  7. 4 chamber view • This presents an axial view of the fetal thorax. • Apical 4 chamber view : cardiac apex is directed towards the transducer and the interventricular septum is aligned with the insonating beam . • Transverse 4 chamber view: the interventricular septum is at 90 angle with the insonating beam .

  8. The checklist of 4 chamber view • Two-third of the heart in the left hemithorax • The cardiac apex pointing to the left of the midline with a 45(+,-20) cardiac axis • At least two of the PVs draining to the left atrium • Two atria of similar size • The flap of the foramen ovale into the left atrium • Two separated atrioventricular valves • Two separated ventricles of similar size • Free right and left myocardial walls of similar thickness • An intact interventricular septum

  9. Standard 4 chamber view

  10. Cardiac Axis

  11. This is an axial view of the upper mediastinum .The three vessels are (from right to left) , SVC , the Aorta , and the PA. 3-vessel view

  12. Long axis of left ventricle • This view is obtained by rotating the transducer slightly towards the right fetal shoulder .

  13. Checklist : • The presence of a vessel that connects with LV. • Septo-aortic continuity . • Semilunar valve with normal systo-diastolic excursion . • The presence of crossover.

  14. Long axis of right ventricle • This view is obtained from the long axis of the LV by curving the transducer towards the fetal head .

  15. Checklist : • The presence of a vessel that connects with RV. • Semilunar valve with normal systo-diastolic excursion . • The presence of crossover. • The size of the vessel is similar or slightly larger than Aorta .

  16. Short axis of the Right ventricle • To obtain this view from the 4-chamber view ,the transducer should perform a rotation mirroring that needed for the long axis of the LV. Checklist: • Same as for the long axis of the RV.

  17. In this longitudinal view of the fetal thorax , both vanae cavas are seen entering the right atrium (seagull wings view) Checklist: Presence of both venae cavae . Both venae cavae should have the same size. Cavo-atrial junction

  18. Longitudinal view of the Aortic Arch On this view the whole course of the Aorta from the left ventricle to the abdominal Aorta , is displayed. The aortic arch has regular diameter with 3 vessels of the head and neck .

  19. Ductal arch view Ductal arch takes a trajectory that is practically rectilinear , anteroposterior ,beginning in the retrosternal region with a ductal arch of an obtuse angle.

  20. Before going into the details of the examination we begin by taking a quick preliminary look round the entire area . We move up wards perpendicular to the axis of the spine towards the cephalic pole , beginning from the transverse abdominal view ,and the pass to the 4 chamber view , and then beginning of the aorta and pulmonary trunk . Continuing the movement , we see the horizontal portion of the aortic arch and 3 vessel view. A FAST GLANCE :

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