evaluation of fetal heart

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!