Fetal heart ultrasound : how, why, and when. 3 steps and 10 key points

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Front cover Fetal Heart Ultrasound Copyright page Table of Contents Website contents Foreword to the first edition Foreword to the first edition Acknowledgments Abbreviations 1 Why: fetal heart ultrasound Chapter contents General notions Criteria for normality Review Development Anatomic ultrasound correlations The crux of the heart Outflow The great vessels The arches Several fetal hemodynamic elements Examples of inlet pathologies Examples of outlet pathologies Application to fetal cardiopathies The concept of the architectural spectrum Etiologic orientation References 2 How: technical aspects Chapter contents The physical principles of ultrasound as applied to fetal ultrasound Tissue elasticity Example of tissue elasticity Reflection of ultrasound The principle of the shortest path Going around obstacles What takes time? The surface to be explored The number of crystals stimulated Distance traveled from the point of view of time The number of focal zones The use of color Doppler The physical principles of doppler Doppler color and time Continuous Doppler Pulsed Doppler Color Doppler Power Doppler Incident angle Example Pulse repetition frequency and aliasing The 3D technique In practice: the settings In practice: setting the controls The 2D settings Zoom Example of using the zoom Focus Gain Preset elements Dynamic range Frequency The density of pulse lines per image Persistence Contours Doppler settings The direction of the incident wave Pulse repetition frequency Color gain Application to the examination of the fetal heart The echo-structure The position of the fetal heart The movements Further reading 3 How: anatomic–ultrasound correlations: 3 steps, 10 key points Chapter contents First step. verification of the position: 2 key points In practice Verification of lateralization Position of the organs Vessel position Axis of the heart Second step. verification of the inlet: 4 key points In practice Point 3: the heart is attached by the inferior PV Points 4 and 5: the four chambers should be balanced and concordant Point 6: the two permeable and offset atrioventricular valves Third step. verification of the outlet: 4 key points In practice Point 7: the verification of septal– and mitral–aortic continuity Point 8: crossing of the two vessels Point 9: balance and concordance of the vessels Point 10: regular aortic arch References 4 How: conducting the examination and its pitfalls Chapter contents Taking the history A fast glance Different views that verify the 10 key points, their pathways, and their pitfalls Verification of lateralization and its pitfalls: the elevator The technique Pitfalls The position of the fetus: lateralization elements Organ position Abdominal vessel position Four-chamber view: verification of the outlet and its pitfalls The technique The axial–apical pathway Why How The axial–transverse pathway Why View of the crux of the heart Why How Pitfalls of the inlet or four-chamber view The axis of the heart and the aorta to the left The axis of the heart Swings in the four-chamber view Lateral swings: asymmetries For an inferior–superior swing: false AVSD and VSD Four-chamber view and concordance Aspect of a false echogenic tumor of the right ventricle Four-chamber view and foramen ovale valve Verification of the outlet and its pitfall The LV–Ao view The technique The axial–apical LV–Ao view Why The preferred axial–lateral view Why The LV–Ao “SOS” view: sagittal oblique Why How Pitfalls of the LV–Ao view The RV–PT view Axial transverse view Why How View of the right tract, small axis Why How Pitfalls of the RV–PT view The three-vessel view or the two crosses Why How Pitfalls of a normal three-vessel view Sagittal view of the aortic arch Why How Pitfalls of the aortic arch view References Further reading 5 First-trimester cardiac scan and study Chapter contents Introduction Why? Who? What? When? How? Technical aspects: equipment Tissue harmonic imaging (THI) Compound imaging Post-processing Technical aspects: settings Color flow modalities Color Doppler Power Doppler B/E-flow ultrasound Technical aspects: summary Examination: risk factors Nuchal translucency (NT) Tricuspid valve regurgitation Ductus venosus Risk factors: in summary Anatomic correlation and its limitations Step 1: verification of the position of the heart Step 2: verification of the inlet Step 3: verification of the outlet tract Fetal cardiologists Pathologists Histological imaging Magnetic resonance imaging Computed tomography References Further reading 6 Why: critical cardiac pathologies not to be overlooked Chapter contents First step. pathologies of position Anomalies of visceral positioning Vessel position anomalies Not one but two vessels in front and to the left of the spine on the TAD image Anomalies of organ or vessel position at the abdominal level, which are present in VAH, are elements of orientation The descending aorta is found— not in front and to the left—but on the right of the spine in the four-chamber view Anomalies concerning the position of the heart Anomalies that modify the axis of the heart The angle can be clearly superior to 45 with a distinct asymmetry of the chambers The inlet chambers remain symmetric The angle can be inferior to 45° The axis can be negative with the apex of the heart to the right Second step. pathologies of the inlet Point 3: heart on the diaphragm Point 4: if we cannot distinguish the four chambers Three chambers Four+ chambers Five chambers Point 5: asymmetric or discordant chambers If the chambers are asymmetric we can distinguish a variety of architectural malformations In cases where the chambers are discordant Point 6: rings that are impermeable or not offset Third step. pathologies of the outlet Point 7: pathology Point 8: the verification of the crossing over of the great vessels is a critical moment Point 9: a lack of balance can involve several elements A lack of balance between the chambers Vessel imbalance Point 10: irregular aortic arch Attention References 7 When: fetal morphological examination after the discovery of a cardiopathy Chapter contents Two possibilities exist The karyotype is unknown Warning signs of chromosomal anomalies Trisomy 21 (T21; Down syndrome) Trisomy 18 (T18; Edwards syndrome) Trisomy 13 (T13; Patau syndrome) Turner syndrome Triploidy The karyotype is known to be normal Fetal alcohol syndrome Smith–Lemli–Opitz syndrome (SLOS) The CHARGE association Cornelia de Lange syndrome Cardiopathies associated with skeletal anomalies Long bones Cardiopathies associated with cephalic anomalies Cardiopathy associated with visceral anomalies References 8 Points to remember Chapter contents Technical points to remember Key points to remember Pathologies to remember The position anomalies The inlet anomalies Outlet anomalies Morphological points to remember Conclusion Index A B C D E F G H I K L M N O P R S T U V W Z