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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