Download Pitfalls in Fetal Echocardiography

Pitfalls in Fetal Echocardiography
Jung Yun Choi
Department of Pediatrics
Seoul National Univ. Children’s Hospital
Pitfalls of Fetal Echocardiography
• Pitfalls due to technical factors
• Pitfalls related to interpretation
Pitfalls due to technical factors
Structural Image
Doppler Spectral Image
Color Doppler image
Pitfalls in Structural Image
Echo drop-out
Artifact : Shadowing
Imperfect resolution
Slice thickness
Echo drop-out; Shodowing; Artifact
Pitfalls in Color Doppler image
Low frame rate
Poor range resolution
Poor velocity resolution
Range resolution
Velocity resolution
Resolution of color Doppler study
Velocity Scale Change
Transducer Frequency Change
Pitfalls in assessing size
Normal size
Large heart
Small heart
Normal size
• What is normal ? Mean ± 2 SD
• Growth parameters : gestational period,
body weight, head circumference, height, etc
• Heart parameters : dimension, area, volume
Large Heart
• Right or left or both sides
• Causes
– cardiac malformation
– valvular or ventricular dysfunction
– secondary to fetal diseases
• Effects on fetus; long-term effects
Small Heart
• Anatomic definition: diameter / area below - 2 SD ?
• Functional definition : too small to be a ventricle
• Growth parameters : body weight > gestational age
• Any potential of catch up growth ?
How small?
• Too small: hardly seen, no potential of growth
• Questionable
• Not too small: -2 ~ -3 SD, may have a potential
Too Small Heart
• Causes : HLHS, HRHS
• How to assess : PFO, ductus, coronary fistula
• Counsel : single ventricle and Fontan
Not Too Small
• Causes: unknown, COA, AS, MS, PS etc
• How to assess: complete study on heart / vessel
• Counsel : cautious optimism
An example of LV being ‘Not Too Small’
An example of LV being ‘Not Too Small’
Pitfall in Natural History
• Newly diagnosed in the 3rd trimester
• Cardiac malformations become worse
• Cardiac defects / diseases become better
Newly diagnosed in the 3rd trimester
• Cardiac malformation
• Cardiomyopathy
• Cardiac tumor
• Secondary cardiac disease
Natural History
May get worse
May get better
May stay the same
Pitfalls in Arrhythmia
• Technical pitfalls: difficult to obtain signal
• Interpretation: requires thorough knowledge
• Common mistake
– transient bradycardia
– intermittent premature contraction
M-mode is difficult to obtain
Frequently
Poor Tracing: difficult to
identify wall motion
← Ventricular wall
← Mitral valve
← Atrial wall
Occasionally
Good Tracing : Atrial wall
contraction precedes mitral valve
closure and ventricular contraction
← Ventricular wall
← Mitral valve
← Atrial wall
Premature Atrial Contraction
Brief bradycardia is common
Intermittent premature contraction is frequent