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Congenital Heart Disease
8 per 1000 live birth (3 in 1000 is
critical)
True incidence is higher in the fetus
(abortuses and stillborns) --- as high
as 5x
Intrauterine cardiac malformations
are associated with a high incidence
of infant mortality and fetal wastage
Most common congenital
malformation
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Fetal Echocardiography
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Importance of ID of Heart
Disease in Utero
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Heart Defects Which Need
INTERVENTION
in the Perinatal Period
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When is the ideal time?
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20-week Fetal Heart
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Indications for FETAL ECHO
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Technique
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The accuracy is also very
much dependent on the
SONOGRAPHER’s
knowledge and
experience.
Understanding of the
cardiac anatomy and
physiology is mandatory.
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Fetal Circulation
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The American College of
Obstetrics and Gynecology
(ACOG) , 1988
4 chamber view of the fetal
heart
on a prenatal screening
ultrasound
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Calculating Fetal Heart Size
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Normal Cardiac Axis
sternum
left
spine
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4-Chamber and ShortAxis of
Ventricles
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Normal Doppler:Aorta
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Doppler Flow:Tricuspid Valve
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Color Doppler: Aortic Arch
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Color Doppler : Foramen Ovale
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4-Chamber View
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4 Chamber View
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Pseudo VSD
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Subcostal 4-Chamber View
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4 Chamber View Alone
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How accurate?
Various recent studies have reported
sensitivity of 43-96% and a
specificity approaching 100% with
the variation depending on the
sample population and technique
employed, including interpretation.
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Reasons for NON-detection
(FALSE NEGATIVES)
Unique fetal circulatory pathways
(PFO,PDA)
Poor image quality of the fetus
Early (<20 wks) or later (>34 wks)
Obesity
Low-quality machines
Milder obstructive lesions can develop late
Small defects
Unusual defects
Inexperienced echocardiographer, erroneous
interpretation
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CHDs with normal 4-
Chamber View
TOF
DORV
Truncus Arteriosus
Outlet VSDs
D-TGA
Coarctation of the Aorta
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The accuracy of detecting
CHDs on a screening
ultrasound improves with
the addition of OUTFLOW
tract evaluation.
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Long-axis View of the Aorta
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Short-axis View of
the Great Vessels
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Aortic Arch
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What CHDs are usually and
easily diagnosed?
Enlargement or hypoplasia of atrium or
ventricle
Atresia of tricuspid or mitral valve
Atresia of pulmonary valve or aortic valve
Large septal defects
Functional abnormalities
Abnormal heart rhythm
Abnormal contractility
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Endocardial Fibroelastosis
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Complete AVSD
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Ebstein’s Anomaly
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HLHS with Hydrops Fetalis
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Truncus Arteriosus
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CHDs not always diagnose
prenatally
Small VSD
Mild pulmonary or aortic stenosis
Branch pulmonary artery stenosis
Anomalous pulmonary venous
connection (especially partial)
Cardiac tumors (small)
Coarctation of the aorta (mild)
PDA and ASD
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The cases of CHD
detectable on FETAL ECHO
constitute a more severe
cardiac anomaly with a less
favorable long-term
prognosis than the more
minor defects infrequently
detected.
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Serial fetal echo
examinations improve
accuracy and gives us a
good picture of disease
progression especially in
high-risk conditions.
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Functional Abnormalities
Chamber sizes, wall thickness
Contractility (Ejection Fraction,Fractional
Shortening)
AV Valve Regurgitation
RHYTHM
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HLHS with Hydrops Fetalis
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M-mode Measurements
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M-Mode Tracing
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Hypertrophic
Cardiomyopathy
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Fetal Arrhythmias
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Sinus Rhythym
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Normal Sinus Rhythm:
Doppler Method
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Fetal Arrhythmias
1% of fetuses
Repetitive Irregular
Heartbeats
Unexplained Hydrops Fetalis
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Fetal Arrhythmias
Self limited
Resolves spontaneously
Carries a benign prognosis though it
may persist for a variable period
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Premature Atrial Contractions
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Fetal Arrhythmias
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Significant Fetal Arrhythmias
Most Common
SUPRAVENTRICULAR
TACHYCARDIA (SVT)
ATRIAL FLUTTER
Most common
When sustained for 24 hours ---
HYDROPS FETALIS
DIGOXIN is still drug of choice
Procainamide,
Quinidine,Verapamil, Sotalol
and Amiodarone
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Supraventricular Tachycardia
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Fetal Atrial Flutter
Difficult to treat
Digoxin remains drug of
choice
Guarded prognosis in
about 20%
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Atrial Flutter
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Fetal Complete Heart Block
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Complete Heart Block
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Complete Heart Block
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Summary
Fetal cardiology has made great strides in
the detection of fetal heart disease thru
FETAL ECHOCARDIOGRAPHY
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Summary
Fetal Echo enables us to diagnose
structural and functional heart disease
in-utero as early as 16 wks of AOG
4-chamber and outflow tract views are
important to diagnose more than 90% of
heart disease
Some CHDs are difficult to diagnose in-
utero (but are not critical)
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Summary
Most common indications for evaluation
are suspected CHD on level 1 ultrasound,
chromosomal abnormalities,
extracardiac anomalies, family history of
CHD, maternal diabetes and maternal
teratogen exposure
Prenatal diagnosis of CHD may alter the
natural course of CHD and improve on
the perinatal morbidity and mortality
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THANK YOU
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