comprehensive first trimester cardiac assessment...
TRANSCRIPT
![Page 1: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/1.jpg)
COMPREHENSIVE FIRST TRIMESTERCARDIAC ASSESSMENT
Reem S. Abu-Rustum, MD, FACOG, FACS, FAIUMCenter For Advanced Fetal Care
Tripoli - Lebanon
AIUM Annual Convention NYC 18 March 2016
R
L
![Page 2: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/2.jpg)
OBJECTIVES
Background
Why Early?
What Can We See?
Learning Curve
Guidelines & Data
Conclusions
R
L
![Page 3: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/3.jpg)
Background
Why Early?
What Can We See?
Learning Curve
Guidelines & Data
Conclusions
![Page 4: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/4.jpg)
IT ALL STARTS WITH…
![Page 5: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/5.jpg)
IT ALL STARTS WITH…… A HEARTBEAT
8w3d
![Page 6: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/6.jpg)
CONGENITAL HEART DISEASE
Pentalogy of Cantrell
Hoffman et al. Am J Cardio 1978; 42:641Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography: Normal and Abnormal Hearts. 2nd Edition
• Most common major abnormality
• Incidence: 8.8/1000 live births
• 30% with associated defects
• Contributes to >50% of congenital anomaly-related deaths in childhood
• Majority: no risk factors
• MUST screen the entire population
![Page 7: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/7.jpg)
HOW GOOD ARE WE?
![Page 8: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/8.jpg)
Tegnander et al. UOG 2006; 27:252
• Non-selected population in Norway
• 30149 fetuses
Detection Rate at
57%
HOW GOOD ARE WE?
![Page 9: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/9.jpg)
Friedberg et al. J. Pediatr. 2009; 155:26
• Prospective 1 year study
• Northern California
• Fetuses and infants with CHD < 6 months
HOW GOOD ARE WE?
![Page 10: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/10.jpg)
Friedberg et al. J. Pediatr. 2009; 155:26
HOW GOOD ARE WE?
![Page 11: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/11.jpg)
CAN WE IMPROVEOUR DETECTION?
![Page 12: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/12.jpg)
Hunter et al. Heart 2000; 84:294
Prenatal recognition of CHD rose from 17% in 1994 to 30% in 1995 and36% in 1996.
Conclusions—A simple training program for obstetric ultrasonographersincreased their ability to detect serious congenital heart disease at aroutine 18–20 week anomaly scan.
![Page 13: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/13.jpg)
Background
Why Early?
What Can We See?
Learning Curve
Guidelines & Data
Conclusions
![Page 14: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/14.jpg)
WHY DETECT EARLY?MAIN CONSIDERATIONS
• Workup• Options• TOP Limitations• Safety• Explain sudden IUFD• Natural progression• Psychological• Obstetrical care
• Early Reassurance
Courtesy of Prof. Nicolaides
De
ath
s /
10
0,0
00
ab
ort
ion
s
Abortions in the USA 1988-1997
Bartlett et al 2004
10 12 14 16 18 20
0
2
4
6
Gestation (wks)
0.5
4
Barlett et al. Obstet Gynecol 2004; 103:729
![Page 15: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/15.jpg)
WHY DETECT EARLY?MAIN CONSIDERATIONS
Maiz et al. Prenatal Diagnosis 2016; ePub ahead of print.
![Page 16: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/16.jpg)
GLOBAL IMPLEMENTATIONAS A RESULT OF
NT
Technical Advances
NIPT
CAx
![Page 17: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/17.jpg)
GLOBAL IMPLEMENTATIONAS A RESULT OF
NT
Technical Advances
NIPT
CAx
![Page 18: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/18.jpg)
Salveson et al. UOG 2011; 37:625
![Page 19: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/19.jpg)
NT RISK OF CHD
2.5-3.4 x2
3.5-4.4 x4 (3% )
4.5-6.4 x6.5 (10%)
5.5-6.5 x14
> 6.5 x26 (20%)
Allan, Cook & Huggon. Fetal Echocardiography: A Practical Guide. 2009Hyett et al. UOG 1997; 10:242
NUCHAL TRANSLUCENCY
![Page 20: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/20.jpg)
• Cardiac Abnormalities 5/1000 (0.5%)
• Diabetic Mom 10-15/1000 (1-1.5%)
• Previous Affected Child 20/1000 (2%)
• NT > 3.5 mm 50-70/1000 (5-7%)
Hyett et al.UOG 1997; 10:242Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography: Normal and Abnormal Hearts. 2nd Edition
NUCHAL TRANSLUCENCY
![Page 21: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/21.jpg)
Sotiriadis et al. UOG 2013; 42:383
![Page 22: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/22.jpg)
Sotiriadis et al. UOG 2013; 42:383
![Page 23: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/23.jpg)
GLOBAL IMPLEMENTATIONAS A RESULT OF
NT
Technical Advances
NIPT
CAx
![Page 24: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/24.jpg)
WITH THETECHNOLOGICAL ADVANCES
![Page 25: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/25.jpg)
Sinkovskaya et al. UOG 2012; 40:90
HD FLOW 13W1D
R
L
![Page 26: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/26.jpg)
![Page 27: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/27.jpg)
SAo
RV
RALV
LA
3VVAo
PA
FO
3D VOLUME AT 13W2D
RS Abu-Rustum. A Practical Guide to 3D Ultrasound. CRC Press 2015
![Page 28: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/28.jpg)
Votino et al. UOG 2013; 42:669
![Page 29: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/29.jpg)
AIUM 2011
SAFETYIN THE FIRST TRIMESTER
![Page 30: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/30.jpg)
ISUOG 2011
SAFETYIN THE FIRST TRIMESTER
![Page 31: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/31.jpg)
GLOBAL IMPLEMENTATIONAS A RESULT OF
NT
Technical Advances
NIPT
CAx
![Page 32: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/32.jpg)
![Page 33: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/33.jpg)
WITH NIPT…
…A SHIFT IN THE ROLE OF NT
BEYOND SCREENING FOR ANEUPLOIDY
![Page 34: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/34.jpg)
FULL ANATOMIC SURVEY
![Page 35: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/35.jpg)
FULL ANATOMIC SURVEY
![Page 36: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/36.jpg)
Genitalia
Bladder + 3VC
FULL ANATOMIC SURVEY
R
L
![Page 37: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/37.jpg)
INCLUDING THE FETAL HEART…
IVC
SVC
RA
DAo
RL
RL
![Page 38: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/38.jpg)
Larion et al. AJOG 2014: 65121
![Page 39: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/39.jpg)
KEEPIN MIND…
Dolk et al. Adv Exp Med Biol. 2010; 686:349
![Page 40: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/40.jpg)
PRIOR TO NIPT, CRITICAL TO RULE OUT
![Page 41: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/41.jpg)
AND MAJOR CONGENITAL HEART DEFECTS
HLH 13w3d
R
L
R L
![Page 42: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/42.jpg)
GLOBAL IMPLEMENTATIONAS A RESULT OF
NT
Technical Advances
NIPT
CAx
![Page 43: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/43.jpg)
43
THE FIRST TRIMESTER HEART
OFT
3VV
4CV
![Page 44: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/44.jpg)
KEEPING IN MIND……THE DIFFICULTY
OFT4CV
AoA & DAoBicaval View
![Page 45: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/45.jpg)
NT RISK OF CHD
2.5-3.4 x2
3.5-4.4 x4 (3% )
4.5-6.4 x6.5 (10%)
5.5-6.5 x14
> 6.5 x26 (20%)
Allan, Cook & Huggon. Fetal Echocardiography: A Practical Guide. 2009Hyett et al. UOG 1997; 10:242
NUCHAL TRANSLUCENCY
![Page 46: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/46.jpg)
Sinkovskaya et al. UOG 2010; 36:676 Sinkovskaya et al. UOG 2014; 44:10
CARDIAC AXIS 30-60 FTS
R
L
![Page 47: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/47.jpg)
Sinkovskaya et al Obstet Gynecol 2015; 125: 453
![Page 48: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/48.jpg)
Sinkovskaya et al Obstet Gynecol 2015; 125: 453
![Page 49: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/49.jpg)
Sinkovskaya et al Obstet Gynecol 2015; 125: 453
![Page 50: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/50.jpg)
Sinkovskaya et al Obstet Gynecol 2015; 125: 453
![Page 51: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/51.jpg)
Background
Why Early?
What Can We See?
Learning Curve
Guidelines & Data
Conclusions
![Page 52: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/52.jpg)
EARLIEST REPORTS
Gemburch et al. Obstet Gynecol 1990; 75:496
Achiron et al. J Ultrasound Med 1994; 13:783
12
14
20
![Page 53: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/53.jpg)
MORE RECENTLY…
• Haak et al
UOG 2002; 20:9
Transvaginal 92%
• Huggon et al
UOG 2002; 20:22
Transabdominally 84%
R
L
R
L
![Page 54: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/54.jpg)
Haak et al. UOG 2002; 20:9
Transvaginal
![Page 55: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/55.jpg)
Huggon et al. UOG 2002; 20:22
Transabdominal
![Page 56: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/56.jpg)
DeVore. UOG 2002; 20:6
NEWEST TREND: CARDIAC IMAGING AT 11-14 WEEKS
![Page 57: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/57.jpg)
KEEPING IN MIND…
12
14
20
Grain Rice Coin: 1 Euro
Allan, Cook & Huggon. Fetal Echocardiography: A Practical Guide. 2009
![Page 58: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/58.jpg)
Key Points• Heart Develops GA 5-8 Weeks• Chest AP diameter is about 2.5 cm at 12-13 weeks
Can Assess• Position• Connections• Symmetry of 4 Chambers• 2 AV valves/Septum (Doppler)• Septoaortic Continuity• 2 Semilunar Valves (Doppler)• Normal Cross Over of Arteries
58
CARDIAC IMAGING AT 11-14 WEEKS
R
L
![Page 59: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/59.jpg)
ANATOMIC LANDMARKS
• Right ventricle is the most anterior, below thesternum
• Left atrium is closest to the spine most centralstructure in the chest
• Aorta is just anterior to the left of the spine
• Tricuspid valve is more apical than mitral valve
• Flap of the foramen ovale in the left atrium
• Moderator band is in the right ventricle
• Apex formed by the left ventricle
R
L
![Page 60: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/60.jpg)
• Left atrium and aorta occupy the center of the chest
• Aorta points to the right shoulder as it exits then heads posteriorlytowards the spine
• Pulmonary artery (PA) points to the left shoulder as it exits
• Outflow tracts cross over, with the PA being more anterior than the left ventricular outflow tract
• Post bifurcation of the PA, the aorta and PA are almost parallel
ANATOMIC LANDMARKS
RL
R
L
![Page 61: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/61.jpg)
SYSTEMIC EVALUATION TRANSVERSE VIEWS
ISUOG FE Guidelines 2013
![Page 62: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/62.jpg)
SYSTEMIC EVALUATION SAGITTAL VIEWS
![Page 63: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/63.jpg)
SYSTEMIC EVALUATION TRANSVERSE VIEWS
ISUOG FE Guidelines 2013
![Page 64: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/64.jpg)
Abd Circ
Apex4CV
LVOT-Ao
RVOT-PA
3VV
Diagram Courtesy of Linda Daou, MD
SYSTEMIC EVALUATION TRANSVERSE VIEWS
![Page 65: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/65.jpg)
Abd Circ
Apex4CV
LVOT-Ao
RVOT-PA
3VV
Diagram Courtesy of Linda Daou, MD
SYSTEMIC EVALUATION TRANSVERSE VIEWS
![Page 66: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/66.jpg)
TV at 11w3d Using RIC 6-12
ESTABLISHING SITUS
R
L
![Page 67: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/67.jpg)
ESTABLISHING SITUS
RR
L
![Page 68: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/68.jpg)
ESTABLISHINGSITUS
R
L
R
L
![Page 69: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/69.jpg)
69
4 CHAMBER VIEW
R
L
![Page 70: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/70.jpg)
TV at 11w2d Using RIC 6-12
4 CHAMBER VIEW
RALV
LA
RV
![Page 71: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/71.jpg)
R
L
Sinkovskaya et al. UOG 2010; 36:676
CARDIAC AXIS 30-60 FTS
![Page 72: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/72.jpg)
TRICUSPID REGURGITATION
![Page 73: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/73.jpg)
PULMONARY VEINS
R
L
![Page 74: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/74.jpg)
PULMONARY VEINS
TA at 13w1d Using Linear 9MHz Probe
RL
![Page 75: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/75.jpg)
Abd Circ
Apex4CV
LVOT-Ao
RVOT-PA
3VV
Diagram Courtesy of Linda Daou, MD
SYSTEMIC EVALUATION TRANSVERSE VIEWS
![Page 76: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/76.jpg)
76
OUTFLOW TRACTS
R
L
R
L
![Page 77: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/77.jpg)
OUTFLOW TRACTS
![Page 78: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/78.jpg)
OUTFLOW TRACTS
TA at 13w5d Using RMC/OB
RVOT LVOT
R
L
R
L
![Page 79: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/79.jpg)
CROSS OVER
![Page 80: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/80.jpg)
Abd Circ
Apex4CV
LVOT-Ao
RVOT-PA
3VV
Diagram Courtesy of Linda Daou, MD
SYSTEMIC EVALUATION TRANSVERSE VIEWS
![Page 81: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/81.jpg)
3 VESSEL VIEW
PA
AoSVC
DAo
DA
![Page 82: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/82.jpg)
TV at 13w1d Using RIC 6-12
3 VESSEL VIEW
PAAo
SVC
DAoDA
![Page 83: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/83.jpg)
TV at 9w5d Using RIC6-12
PA AoSVC
DAoDA
3 VESSEL VIEW
![Page 84: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/84.jpg)
TA at 13w0d Using RM6C/OB
SYSTEMIC EVALUATION TRANSVERSE VIEWS
R
L
![Page 85: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/85.jpg)
TA at 13w2d Using RM6C/OB
SYSTEMIC EVALUATION TRANSVERSE VIEWS
![Page 86: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/86.jpg)
SAo
RV
RALV
LA
3VVAo
PA
FO
3D VOLUME AT 13W2D
RS Abu-Rustum. A Practical Guide to 3D Ultrasound. CRC Press 2015
![Page 87: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/87.jpg)
SYSTEMIC EVALUATION SAGITTAL VIEWS
![Page 88: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/88.jpg)
IVC
SVC
RA
DAo
RIGHT ATRIAL INFLOW
![Page 89: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/89.jpg)
TA at 12w6d Using RM6C/OB
RIGHT ATRIAL INFLOW
![Page 90: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/90.jpg)
RIGHT ATRIAL INFLOW
TV at 13w1d Using RIC 6-12
RASVC
IVC
![Page 91: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/91.jpg)
AORTIC ARCH & DESCENDING AORTA
![Page 92: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/92.jpg)
TA at 13w2d Using RM6C/OB
AORTIC ARCH & DESCENDING AORTA
![Page 93: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/93.jpg)
TV at 13w1d Using RIC 6-12
AORTIC ARCH & DESCENDING AORTA
![Page 94: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/94.jpg)
DUCTAL ARCH
![Page 95: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/95.jpg)
DUCTAL ARCH
AoA
DA
![Page 96: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/96.jpg)
DUCTUS VENOSUS
![Page 97: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/97.jpg)
ONCE WE RECOGNIZE NORMAL ANATOMY WE CAN IDENTIFY THE ABNORMALS
![Page 98: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/98.jpg)
ONCE WE RECOGNIZE NORMAL ANATOMY WE CAN IDENTIFY THE ABNORMALS
Univentricle 12w2d
![Page 99: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/99.jpg)
ONCE WE RECOGNIZE NORMAL ANATOMY WE CAN IDENTIFY THE ABNORMALS
AV Canal 13w5d
R
L
R
L
R
L
![Page 100: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/100.jpg)
Abu-Rustum, Ayoubi and Jani. UOG 2011; 38:190
Left CDH at 12w5d
ONCE WE RECOGNIZE NORMAL ANATOMY WE CAN IDENTIFY THE ABNORMALS
R
L
![Page 101: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/101.jpg)
THE LEBANESE CAx
CoA
TOF HLH AV Canal
VSDHLHCAx 82.02
CAx 78.05
CAx 84.98 CAx 65.90
CAx 85.60 CAx 13.15
![Page 102: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/102.jpg)
Background
Why Early?
What Can We See?
Learning Curve
Guidelines & Data
Conclusions
![Page 103: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/103.jpg)
MUST ACQUIRE SKILLIN THE SECOND TRIMESTER
24W5D21W5D
RS Abu-Rustum. A Practical Guide to 3D Ultrasound. CRC Press 2015
![Page 104: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/104.jpg)
SYSTEMIC APPROACH18-22 WEEKS
RL
![Page 105: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/105.jpg)
BEFORE MOVINGTO THE FIRST TRIMESTER
OFT4CV
AoA & DAoBicaval View
![Page 106: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/106.jpg)
NOW WE GO TONORTH LEBANON
![Page 107: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/107.jpg)
Abu-Rustum et al. JUM 2011; 30:695
![Page 108: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/108.jpg)
4CV PV CODoppler of 4CV 3VV LVOT 3VVBPA RV Inflow
To assess the learning curve and factors influencingthe feasibility of carrying out a complete fetalcardiac evaluation at the time of the first trimesterscan.
OBJECTIVE
![Page 109: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/109.jpg)
4CV PV CODoppler of 4CV 3VV LVOT 3VVBPA RV Inflow
•Prospective study•104 gravidas at 11w6d-13w6d•Maternal body mass index BMI•Fetal crown-rump length CRL•Transabdominal scans•Single sonologist•8 cardiac parameters•Average time: first to last cardiac image
METHODS
![Page 110: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/110.jpg)
4CV PV CODoppler of 4CV 3VV LVOT 3VVBPA RV Inflow
CARDIAC PARAMETERS1. 4 Chamber view (4CV)2. Tricuspid regurgitation (TR)3. Outflow tracts cross over (CO)4. Bifurcating pulmonary artery (BPA)5. 3 Vessel view (3VV)6. Aortic arch sagitally (AoA)7. Bicaval view (RA Inflow)8. Doppler of the ductus venosus (DV)
METHODS
![Page 111: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/111.jpg)
4CV PV CODoppler of 4CV 3VV LVOT 3VVBPA RV Inflow
Data Analysis•Chi square•ANOVA•Scatter plot•Polynomial curve fitting•P < 0.05
METHODS
![Page 112: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/112.jpg)
4CV PV CODoppler of 4CV 3VV LVOT 3VVBPA RV Inflow
•103/104 Fetuses evaluated•Median CRL 72.1 mm (range 53.9-85.8 mm)•Median BMI was 23 kg/m2 (range 17.7-32.3 kg/m2)•A complete exam was feasible in 55% of cases•A complete exam was feasible in 15% of the first 52 cases•A complete exam was feasible in 94% of the last 51 cases
RESULTS
![Page 113: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/113.jpg)
4CV PV CODoppler of 4CV 3VV LVOT 3VVBPA RV Inflow
Cardiac View Successful Visualization
4 Chamber View 100 %
Tricuspid Regurgitation 100 %
Outflow Tract Cross Over 90 %
Bifurcation Pulmonary Artery 81 %
3 Vessel View 55 %
Venae Cavae 65 %
Aortic Arch 76 %
Ductus Venosus 99 %
RESULTS
![Page 114: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/114.jpg)
1st period[Case 1-21]
2nd period[Case 22-52]
3rd period[Case 53-103] p-value
#Views out of 8 4.76 (59.5%) 6.0 (75%) 7.89 (98.6%) 0.0001
Average Time (sec) 262.4 (4.37 m) 429.3 (7.13m) 560.1 (9.3m) 0.032
BMI 24.08 24.0 23.5 0.752
CRL 72.2 72.7 72.1 0.899
4CV PV CODoppler of 4CV 3VV LVOT 3VVBPA RV Inflow
RESULTS
![Page 115: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/115.jpg)
0
10
20
30
40
50
60
70
80
90
100
0 20 40 60 80 100 120
Number of cases
Perc
en
tag
e o
f fi
nd
ing
s
.
Case Number
% C
om
ple
te E
xam
4CV PV CODoppler of 4CV 3VV LVOT 3VVBPA RV Inflow
RESULTS
![Page 116: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/116.jpg)
AV Canal
HRH
R
L
CONCLUSION
• Fetal cardiac evaluation is feasible in the first trimester
• At least 52 exams and an average time of 10 minutesneeded
• Time allocation and gained sonographer experienceare the most significant factors
![Page 117: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/117.jpg)
TECHNICAL/PERSONALLIMITATIONS
Training
Machinery
Maternal Body Habitus
Developmental Stage
Time Consuming
Undue
Anxiety
Greatest challenge is the LOW RISK PATIENT!
![Page 118: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/118.jpg)
Background
Why Early?
What Can We See?
Learning Curve
Guidelines & Data
Conclusions
![Page 119: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/119.jpg)
AIUM 2013 GUIDELINESACOG, ASE & SMFM
ENDORSED BY ACR
![Page 120: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/120.jpg)
ISUOG 2013 GUIDELINES
![Page 121: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/121.jpg)
![Page 122: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/122.jpg)
Carvalho. PD 2004; 24:1060
![Page 123: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/123.jpg)
Rossi et al. AJOG 2013; 122:1160
![Page 124: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/124.jpg)
Rossi et al. AJOG 2013; 122:1160
![Page 125: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/125.jpg)
Background
Why Early?
What Can We See?
Learning Curve
Guidelines & Data
Conclusions
![Page 126: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/126.jpg)
CONCLUSIVE PEARLS
Comfort in the Second Trimester
Commence with Low BMI Patients
Employ Magnification
Use Doppler (HDF) but Adhere to Safety
Concerns
Utilize Various Probes/Routes
Practice & Patience
![Page 127: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/127.jpg)
CONCLUSION
• First trimester fetal cardiac imaging is feasible
• Powerful tool for early reassurance
• Does not replace second trimester echocardiography
• Consultation with Pediatric Cardiology is a MUST
• Though there are no current guidelines, its
incorporation into clinical practice is inevitable
• The future has unlimited potential
• The time to start is NOW
• Practice, PATIENCE and a ready mind make perfect
IS IT TIME FOR FIRST TRIMESTER GUIDELINES?
R
L
![Page 128: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/128.jpg)
IT ALL ENDS WITH……A HEARTBEAT
12w4d
![Page 129: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/129.jpg)
…The Future is so Incredibly Bright
![Page 130: COMPREHENSIVE FIRST TRIMESTER CARDIAC ASSESSMENT …a74195b94871d463a2e2-d7df74e6cafe7f90aab9b1a3addada58.r88.… · Abuhamad & Chaoui. Practical Guide to Fetal Echocardiography:](https://reader034.vdocuments.mx/reader034/viewer/2022052021/6035e9fd73d5282efd5c04d0/html5/thumbnails/130.jpg)
THANK YOU!
Adapted from ‘A Practical Guide to 3D Ultrasound’. RS Abu-Rustum. CRC Press 2015