Fetal Heart Ultrasound - E-Book (eBook)

Front cover 1
Fetal Heart Ultrasound 2
Copyright page 5
Table of Contents 6
Website contents 8
Foreword to the first edition 10
Foreword to the first edition 12
Acknowledgments 14
Abbreviations 16
1 Why: fetal heart ultrasound 18
Chapter contents 18
General notions 19
Criteria for normality 23
Review 25
Development 25
Anatomic ultrasound correlations 28
The crux of the heart 32
Outflow 33
The great vessels 33
The arches 33
Several fetal hemodynamic elements 35
Examples of inlet pathologies 38
Examples of outlet pathologies 39
Application to fetal cardiopathies 39
The concept of the architectural spectrum 40
Etiologic orientation 42
References 42
2 How: technical aspects 46
Chapter contents 46
The physical principles of ultrasound as applied to fetal ultrasound 46
Tissue elasticity 46
Example of tissue elasticity 46
Reflection of ultrasound 47
The principle of the shortest path 47
Going around obstacles 47
What takes time? 49
The surface to be explored 49
The number of crystals stimulated 49
Distance traveled from the point of view of time 50
The number of focal zones 51
The use of color Doppler 52
The physical principles of doppler 52
Doppler color and time 52
Continuous Doppler 52
Pulsed Doppler 52
Color Doppler 52
Power Doppler 52
Incident angle 52
Example 53
Pulse repetition frequency and aliasing 53
The 3D technique 55
In practice: the settings 56
In practice: setting the controls 56
The 2D settings 56
Zoom 56
Example of using the zoom 57
Focus 57
Gain 58
Preset elements 60
Dynamic range 60
Frequency 61
The density of pulse lines per image 61
Persistence 61
Contours 61
Doppler settings 61
The direction of the incident wave 62
Pulse repetition frequency 62
Color gain 64
Application to the examination of the fetal heart 65
The echo-structure 65
The position of the fetal heart 66
The movements 66
Further reading 66
3 How: anatomic–ultrasound correlations: 3 steps, 10 key points 68
Chapter contents 68
First step. verification of the position: 2 key points 69
In practice 69
Verification of lateralization 70
Position of the organs 70
Vessel position 72
Axis of the heart 72
Second step. verification of the inlet: 4 key points 72
In practice 72
Point 3: the heart is attached by the inferior PV 72
Points 4 and 5: the four chambers should be balanced and concordant 74
Point 6: the two permeable and offset atrioventricular valves 74
Third step. verification of the outlet: 4 key points 75
In practice 75
Point 7: the verification of septal– and mitral–aortic continuity 75
Point 8: crossing of the two vessels 75
Point 9: balance and concordance of the vessels 78
Point 10: regular aortic arch 79
References 79
4 How: conducting the examination and its pitfalls 82
Chapter contents 82
Taking the history 82
A fast glance 82
Different views that verify the 10 key points, their pathways, and their pitfalls 87
Verification of lateralization and its pitfalls: the elevator 88
The technique 88
Pitfalls 89
The position of the fetus: lateralization elements 89
Organ position 89
Abdominal vessel position 89
Four-chamber view: verification of the outlet and its pitfalls 91
The technique 91
The axial–apical pathway 94
Why 94
How 94
The axial–transverse pathway 95
Why 95
View of the crux of the heart 95
Why 95
How 95
Pitfalls of the inlet or four-chamber view 97
The axis of the heart and the aorta to the left 97
The axis of the heart 97
Swings in the four-chamber view 97
Lateral swings: asymmetries 99
For an inferior–superior swing: false AVSD and VSD 99
Four-chamber view and concordance 100
Aspect of a false echogenic tumor of the right ventricle 103
Four-chamber view and foramen ovale valve 103
Verification of the outlet and its pitfall 103
The LV–Ao view 103
The technique 104
The axial–apical LV–Ao view 105
Why 105
The preferred axial–lateral view 107
Why 107
The LV–Ao “SOS” view: sagittal oblique 108
Why 108
How 108
Pitfalls of the LV–Ao view 110
The RV–PT view 111
Axial transverse view 113
Why 113
How 113
View of the right tract, small axis 114
Why 114
How 114
Pitfalls of the RV–PT view 114
The three-vessel view or the two crosses 114
Why 114
How 114
Pitfalls of a normal three-vessel view 116
Sagittal view of the aortic arch 116
Why 116
How 116
Pitfalls of the aortic arch view 116
References 118
Further reading 118
5 First-trimester cardiac scan and study 120
Chapter contents 120
Introduction 120
Why? 120
Who? 120
What? 121
When? 121
How? 121
Technical aspects: equipment 122
Tissue harmonic imaging (THI) 125
Compound imaging 125
Post-processing 125
Technical aspects: settings 126
Color flow modalities 127
Color Doppler 127
Power Doppler 129
B/E-flow ultrasound 129
Technical aspects: summary 129
Examination: risk factors 131
Nuchal translucency (NT) 132
Tricuspid valve regurgitation 132
Ductus venosus 133
Risk factors: in summary 134
Anatomic correlation and its limitations 134
Step 1: verification of the position of the heart 134
Step 2: verification of the inlet 135
Step 3: verification of the outlet tract 135
Fetal cardiologists 135
Pathologists 137
Histological imaging 138
Magnetic resonance imaging 138
Computed tomography 138
References 139
Further reading 141
6 Why: critical cardiac pathologies not to be overlooked 142
Chapter contents 142
First step. pathologies of position 142
Anomalies of visceral positioning 142
Vessel position anomalies 143
Not one but two vessels in front and to the left of the spine on the TAD image 143
Anomalies of organ or vessel position at the abdominal level, which are present in VAH, are elements of orientation 144
The descending aorta is found— not in front and to the left—but on the right of the spine in the four-chamber view 145
Anomalies concerning the position of the heart 145
Anomalies that modify the axis of the heart 146
The angle can be clearly superior to 45 with a distinct asymmetry of the chambers 146
The inlet chambers remain symmetric 146
The angle can be inferior to 45° 147
The axis can be negative with the apex of the heart to the right 148
Second step. pathologies of the inlet 149
Point 3: heart on the diaphragm 149
Point 4: if we cannot distinguish the four chambers 149
Three chambers 149
Four+ chambers 150
Five chambers 150
Point 5: asymmetric or discordant chambers 151
If the chambers are asymmetric we can distinguish a variety of architectural malformations 151
In cases where the chambers are discordant 152
Point 6: rings that are impermeable or not offset 152
Third step. pathologies of the outlet 157
Point 7: pathology 158
Point 8: the verification of the crossing over of the great vessels is a critical moment 162
Point 9: a lack of balance can involve several elements 163
A lack of balance between the chambers 163
Vessel imbalance 163
Point 10: irregular aortic arch 164
Attention 164
References 165
7 When: fetal morphological examination after the discovery of a cardiopathy 168
Chapter contents 168
Two possibilities exist 168
The karyotype is unknown 168
Warning signs of chromosomal anomalies 168
Trisomy 21 (T21 Down syndrome)
Trisomy 18 (T18 Edwards syndrome)
Trisomy 13 (T13 Patau syndrome)
Turner syndrome 173
Triploidy 174
The karyotype is known to be normal 175
Fetal alcohol syndrome 177
Smith–Lemli–Opitz syndrome (SLOS) 177
The CHARGE association 178
Cornelia de Lange syndrome 179
Cardiopathies associated with skeletal anomalies 180
Long bones 181
Cardiopathies associated with cephalic anomalies 181
Cardiopathy associated with visceral anomalies 183
References 184
8 Points to remember 186
Chapter contents 186
Technical points to remember 186
Key points to remember 186
Pathologies to remember 187
The position anomalies 187
The inlet anomalies 187
Outlet anomalies 187
Morphological points to remember 187
Conclusion 188
Index 190
A 190
B 191
C 191
D 192
E 193
F 193
G 194
H 195
I 195
K 196
L 196
M 197
N 197
O 197
P 198
R 199
S 199
T 200
U 200
V 201
W 201
Z 201