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Fetal Echocardiography Dr. A. K. KAPOOR Specialist Cardiologist MBBS, MD(Med), DM(Card) What is Congenital Heart Defect? •Congenital heart defects occur during the development of the heart in pregnancy •Most common congenital anomaly (25%) •Affects almost 1 percent of all babies born – and 50 percent of babies with a CHD are seriously affected and will need treatment before 1 year old. What is Fetal Echocardiography? The use of ultrasound waves to investigate the fetal heart-the structure and action of the heart. Multi-disciplinary Team Fetal Circulation Cardiac Embryology Who all should undergo? High Risk Approach FETAL MATERNAL Abnormal 4C view Extracardiac anomalies • GIT, Spina bifida Chromosomal anomalies • Vacterl, Trisomies, Digeorge Non immune hydrops IVF/ICSI Irregular Heart Beat Increased First Trimester NT Abnormal cardiac axis FAMILIAL Maternal CHD Previous child with CHD Maternal auto - immune disease Paternal CHD Teratogen exposure Metabolic disorder • DM, PKU Intra uterine Infections Mendelian Syndromes • TS, Noonan;s, Digeorge Timing of Fetal Echocardiography The best time to do a fetal cardiac exam is 18-22 weeks Later exams may show anatomy better but might be difficult because of rib shadowing Adequate exam depends on fetal position and maternal habitus Some pathologies become obvious with fetal age Fetal Circulation Ultrasound Hand Movements Normal Ultrasound Scan Rate and Rhythm The heart rate is usually 120160/min, the rhythm is regular but transient bradycardia is normal in the 2nd trimester but not in the 3rd Views and Windows Four Chamber View 5 Chamber Apical View Atria Lower end of septum Foramen ovale Flap of foramen ovale in LA Foramen Ovale Basic Fetal Cardiac Examination - Ventricles Moderator band identifies right ventricle Equal size Intact septum Basic Fetal Cardiac Examination – AV Values Both valves move freely Tricuspid valve inserted more apically than mitral Extended basic cardiac examination The outflow tracts are imaged by tilting the probe towards the fetal head The great vessels should be of equal size and should cross at approximately 90° as they emerge from their respective ventricles Outflow Tracts – RVOT/LVOT LVOT Aortic Arch Ductal Arch RVOT Short Access View 4-C view with PD mitral flow LVOT with PD flow Echogenic Intracardiac Focus (EIF) Can be seen in up to 6% of normal pregnancies Highly operator and machine dependant Associated with cardiac and extracardiac anomalies Bilateral EIF is more significant - 38Y, Female - Echogenic Focus - Normal Fetal Echo Study - Normal CV System - 31Y, Female - Multiple Echogenic Focus - Had some evidence of down syndrome - EC Defects – Complex - Child Survived Echogenic Intracardiac Focus (EIF) EIF Biventricular EIF are more significant this patient was 47XY Normal nuchal translucency Pericardial Effusion Hypoplastic left heart Single atrium Large VSD Tricuspid ▪30 Y, Female - Chinese ▪First Child ▪Now Child is 1 Y ▪Fetal Echo TOF TOF Outflow Tract Echocardiography - Tetralogy of Fallot Endocardial Cushion Defect Echocardiography - ECD EBSTEIN ANAMOLY Dextrocardia Echocardiography - Pulmonary Stenosis Echocardiography - Severe Aortic Stenosis Echocardiography - Ventricular Septal Defects WHAT IS ALL ABOUT? ▪THANK YOU Four Chamber View LVOT/RVOT Echogenic Intracardiac Focus DIAGNOSTIC ACUMEN