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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