Download Fetal Echocardiography

FETAL ECHOCARDIOGRAPHY
SARAH E. PERKINS MD
ASSISTANT PROFESSOR OF PEDIATRICS
PEDIATRIC AND PERINATAL CARDIOLOGY
UNIVERSITY OF ILLINOIS CHICAGO
February 1, 2014
History of Fetal Echo
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Early 1970s: Basic m-mode imaging of fetal
cardiac motion used for research purposes.
Late 1970s - early 1980s: Basic two dimensional
ultrasound used to delineate cardiac structure,
function and rhythm.
Initially used primarily for research purposes with
increasing clinical use since that time.
Indications for Fetal Echo
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Familial risk factors
 Sibling
or parent (to the fetus) with congenital heart
disease or a syndrome associated with congenital heart
disease.
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Maternal risk factors
 Teratogen
(many seizure and psychiatric medications,
alcohol)
 Pre-gestational diabetes (Not gestational)
 Phenylketonuria (PKU)
 Maternal lupus (also Sjogren’s)
Indications for Fetal Echo
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Fetal risk factors
Abnormal cardiac views on routine anatomic scan
 Other anomalies on anatomic survey
 Situs abnormities
 Single umbilical artery
 Proven or suspected chromosomal abnormalities (abnormal
quad screen, echogenic focus, increased nuchal thickness,
abnormal cell-free DNA or amniocentesis/CVS results)
 Fetal arrhythmia (Irregular, Tachycardia >180bpm,
Bradycardia)
 Hydrops
 Mono-di twins
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Routine screening for heart disease
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The four chamber cardiac view can be obtained in
95% of fetuses between the late second and early
third trimesters.
Abnormal ventricular function.
 Abnormal rhythm.
 Effusion.
 Some septal defects including AV canal.
 Single ventricle defects.
 Masses/tumors.
 Situs/cardiac position abnormality.
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Four chamber view alone has a sensitivity of only 40%.
Routine screening for heart disease
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The addition of long axis views of the outflow tracts
(aorta and pulmonary artery) increases sensitivity
and specificity.
 Transposition
of the great arteries.
 Stenosis or atresia of an outflow tract.
 Conotruncal abnormalities
 Interrupted aortic arch.
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Additional views are included in the level 2
ultrasound.
 Ductal
and aortic arches.
Echo should also include:
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Systemic venous inflow.
Pulmonary venous inflow.
Foramen ovale.
LV inflow/outflow view.
Orientation of outflow tracts.
Ductal and aortic arches.
Color and spectral Doppler assessment of valves, veins and
arteries.
Rhythm assessment (inflow/outflow and m-mode) including
rate, rhythm, AV interval.
Quantitative assessment of function (EF from short axis).
Umbilical artery/vein and ductus venosus Dopplers.
Timing of fetal echo
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The optimal time for performing fetal echo is 18-24
weeks. Imaging is difficult before this time due to
small size. Complete fetal echo is difficult later in
pregnancy due to curled-up position and increased
mineral content in the fetal skeleton.
Why is prenatal diagnosis important?
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Providing parents with information.
Some may choose termination.
 Allows parents/family to adjust to prepare and adjust.
 Allows pre-natal consultation with specialists, tours of
facilities.
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Treatment.
Maternal anti-arrhythmics for fetal tachycardia.
 Maternal steroids for fetal heart block.
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In-utero interventions.
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Reserved for high-risk lesions.
Why is prenatal diagnosis important?
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Delivery planning.
 When?
 How?
 Where?
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Post-natal management.
 Need
for ICU admission.
 Need for PGE (ductal dependent lesions).
 Management of hemodynamics.
 Availability of cardiac catheterization, ECMO and/or
surgery.
Limitations of fetal echo
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May have limited views.
Early or late in pregnancy.
 Fetal position.
 Maternal body habitus.
 Lung masses.
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Lesions may evolve.
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Multiple serial fetal echos may be needed.
Fetal circulation “masks” some defects.
High pulmonary vascular resistance.
 Altered flow volumes due to fetal structures (placenta,
ductus venosus, foramen ovale, ductus arteriosus)
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Fetal echo can miss:
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Small septal defects (ASD/VSD).
Mild valve or vessel stenosis.
Abnormal pulmonary venous return.
Coarctation of the aorta.
Coronary abnormalities.
PDA, PFO
Thank you!