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BASICS OF FETAL HEART SCANNING
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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
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
Fetal Echocardiography
Indications
Maternal
Fetal
Familial
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%)
Fetal Cardiovascular Assessment
Fetal Cardiac Screen
Detailed Fetal Echocardiogram
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
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
Abdomen and Four-Chambers
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
Ascites/NIHF (20% cardiac)
IVC
Ao
St.
Situs Inversus Totalis
Situs Solitus Situs Inversus
Left Isomerism Right Isomerism
Checklist in Four-Chamber-View I
Size of the heart
Size of the heart
Checklist in Four-Chamber-View I
Position of the heart
Size of the heart
Position of the heart /Shifting
Diaphragmatic hernia
Diaphragmatic hernia
Dextroversion
Position of the heart /Heart axis
Checklist in Four-Chamber-View I
Position of the heart
Size of the heart
Heart axis 45° +- 15°
Heart axis
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°
Hydrops!
RV
LV
LA
RA
Four-Chamber-View
Ao
MV
TV
IAS
IVS
”NORMAL” 4 chamber view
Foramen ovale!
LA
RA
RV
LV
Four-chamber view: The ventricles
Sternum
L
R
RV LV
Atrioventricular discordance
in corrected TGA
LA RA
?
No ventricle Hypoplasia
Left ventricle
RV
LV
„normal“ size Dilated
Left ventricle
RV
LV
Dilated
Left ventricle
LV
RV LV
RV
LV
Hypoplastic LV Hypoplastic RV
Aortic coarctation
Comparison LV/RV width
Single ventricle!
”NORMAL” 4 chamber view
RV
RA
LV
LA
Insertion of AV-valves
Ebstein
Insertion of AV-valves
AVSD
AVSD
AV-Valves: Position and Patency
3 D-AVSD
RV
LV
LA
RA
Ao
Ao
Five-Chamber-View
Connection of the aorta with the LV
3 vessel view
SVC
Aorta
PA spine
Five-Chamber-View
Size of the ascending aorta
Override or not override ?
RV LV
Ao
Normal Overriding
Pulmonary atresia + VSD
Abnormal 4 chamber view:23
wks! !
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
Fetal Echo:Functional Assessment
Ventricular Diastolic Function
LV isovolumetric
relaxation time
M
V
Ao
L EFE Cardiomyopathy
<50ms
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)
4 chamber view
Function, Rhythm and Anatomy
Blocked PAC
37-channel system
Fetal SVT
Fetal intervention! AS
Thank you!
