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Fetal Echocardiography

Fetal Echocardiography. Dr. Durr-e-Sabih Una contribucion para Dr Lattus de Dr. Hector Fernandez. Why. Commoner than most realize 1% in all live births Approximately 5% in all pregnancies. The incidence increases if there is a positive family history

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Fetal Echocardiography

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  1. Fetal Echocardiography Dr. Durr-e-Sabih Una contribucion para Dr Lattus de Dr. Hector Fernandez

  2. Why • Commoner than most realize • 1% in all live births • Approximately 5% in all pregnancies • The incidence increases if there is a positive family history • if sibling affected incidence is 2 – 4% • if mother affected incidence is 10-12%

  3. Indications • Family history • Exposure to known cardiac teratogens • Chromosomal abnormalities (trisomy 21, 50%; trisomy 13 and 18, almost 100%) • Maternal disease (diabetes, collagen disease, phenylketonuria, infections) • Non-cardiac abnormalities detected on US • Polyhydramnios

  4. Cardiac embryology

  5. Cardiac Size 20 week fetus’heart comparedwith an American quarter Usual HR120-160/min

  6. Time • The best time to do a fetal cardiac exam is 18-22 weeks • Later exams may show anatomy better but might be difficult because of rib shadowing • Adequate exam depends on fetal position and maternal habitus • Some pathologies become obvious with fetal age

  7. Fetal Circulation Fetal circulation iscomplex and differentfrom adult blood flowswith three major shunts: Ductus venosusForman ovaleDuctus arterosus

  8. Rate and rhythm • The heart rate is usually 120-160/min, the rhythm is regular but transient bradycardia is normal in the 2nd trimester but not in the 3rd

  9. First assess fetal position

  10. Acquire a four chamber view • Transverse section through the fetal thorax • Corresponds to the 4 chamber apical view in the adult • The atrium nearest the spine is the left atrium • The atrium nearest the fetal anterior thoracic wall is the right

  11. Axis • 45+20o towards the left • Abnormal axis increases the risk of a cardiac malformation • The heart may also be displaced from its normal position in dipaphragmatic hernia or cystic adenomatoid malformation

  12. Fetus cephalic • Probe marker to mother’s left • Fetal spine posterior

  13. Fetus breech • Probe marker normal • Fetal spine posterior

  14. Basic fetal cardiac examination General • Done on a 4 chamber view • Heart mostly in left chest • Occupies 1/3rd of thoracic area • Normal cardiac situs, axis and position • No pericardial effusion

  15. Basic fetal cardiac examination Atria • Both of same size • Foramen ovale flap in left atrium • lower end of atrial septum (septum primum) present

  16. Atria • Lower end of septum • Foramen ovale • Flap of foramen ovale in LA

  17. Basic fetal cardiac examination Ventricles • Equal size • Intact septum • Moderator band • identifies right ventricle

  18. Ventricles • Both of same size • Moderator band identifies rightventricle

  19. Basic fetal cardiac examination AV Valves • Both valves move freely • Tricuspid valve inserted more apically than mitral

  20. Extended basic cardiac examination • The outflow tracts are imaged by tiltingthe probe towards the fetal head • The great vessels should be of equal size and should cross at approximately 90o as they emerge from their respective ventricles

  21. Look for these: • The outflow tracts cross each other at about 90o • The anterior aortic root wall is continuous with the Inter Ventricular Septum • The pulmonary artery bifurcates • The aortic and pulmonary valves move freely • Both great vessels are of similar size but the pulmonary artery tends to be slightly bigger

  22. The aortic arch • The aortic arch canbe identified • The aortic cusps can be seen

  23. The pulmonary artery bifurcates

  24. The outflow tracts cross at around 90o Pulm trunk Aortic arch

  25. Cases

  26. Echogenic Intracardiac Focus (EIF) • Can be seen in up to 6%of normal pregnancies • Highly operator and machine dependant • Associated with cardiacand extracardiac anomalies • Bilateral EIF is moresignificant

  27. EIF Biventricular EIF are more significantthis patient was 47XY Normal nuchal translucency

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