Fetal Echocardiography

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Fetal Echocardiography

• Dr. Avisa Tabib
• Pediatric Cardiologist
• Rajaei Cardiovascular Medical and Research Center

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INDICATIONS

• Fetal
• Abnormal screening obstetric ultrasound.
• Extracardiac anomalies (omphalocele, duodenal
  atresia VACTERL,spina bifida )
• Chromosomal abnormalities (trisomies,
  microdeletion)
• Increased first trimester nuchal translucency
• Nonimmune hydrops
• Tachyarrhythmias
• Bradyarrhythmias

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INDICATIONS

• Maternal
• Diabetes
• Phenylketonuria
• Teratogen exposure (lithium ,phenytoin, valproic
  acid
• ,carbamazepin,isotretinoin )
• Viral infection during first-trimester

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INDICATIONS

• Familial
• Previous child with CHD
• Paternal congenital heart defect
• Tuberous sclerosis
• Noonan syndrome
• Velocardiofacial syndrome

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Timing of Examination

• Assessment of the central cardiovascular
  connection is electively performed from 18 weeks
  gestation onwards. How ever , major CHD can also
  be detected earlier , at 12_ 14 weeks , in
  high-risk cases

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Ultrasound approach and scanning planes

• Axial views
• 4-chamber view
• 3-vessel view
• Oblique views
• long axis of the LV
• long axis of the RV
• short axis of the RV

• Sagittal views
• cavo- atrial junction
• aortic arch
• ductal arch

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4 chamber view

• This presents an axial view of the fetal thorax.
• Apical 4 chamber view cardiac apex is directed
  towards the transducer and the interventricular
  septum is aligned with the insonating beam .
• Transverse 4 chamber view the interventricular
  septum is at 90 angle with the insonating beam .

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The checklist of 4 chamber view

• Two-third of the heart in the left hemithorax
• The cardiac apex pointing to the left of the
  midline with a 45(,-20) cardiac axis
• At least two of the PVs draining to the left
  atrium
• Two atria of similar size
• The flap of the foramen ovale into the left
  atrium
• Two separated atrioventricular valves
• Two separated ventricles of similar size
• Free right and left myocardial walls of similar
  thickness
• An intact interventricular septum

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Standard 4 chamber view
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Cardiac Axis
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3-vessel view

• This is an axial view of the upper mediastinum
  .The three vessels are (from right to left) , SVC
  , the Aorta , and the PA.

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Long axis of left ventricle

• This view is obtained by rotating the transducer
  slightly towards the right fetal shoulder .

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Checklist

• The presence of a vessel that connects with LV.
• Septo-aortic continuity .
• Semilunar valve with normal systo-diastolic
  excursion .
• The presence of crossover.

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Long axis of right ventricle

• This view is obtained from the long axis of the
  LV by curving the transducer towards the fetal
  head .

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Checklist

• The presence of a vessel that connects with RV.
• Semilunar valve with normal systo-diastolic
  excursion .
• The presence of crossover.
• The size of the vessel is similar or slightly
  larger than Aorta .

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Short axis of the Right ventricle

• To obtain this view from the 4-chamber view ,the
  transducer should perform a rotation mirroring
  that needed for the long axis of the LV.
• Checklist
• Same as for the long axis of the RV.

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Cavo-atrial junction

• In this longitudinal view of the fetal thorax ,
  both vanae cavas are seen entering the right
  atrium (seagull wings view)
• Checklist
• Presence of both venae cavae .
• Both venae cavae should have the same size.

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Longitudinal view of the Aortic Arch

• On this view the whole course of the Aorta from
  the left ventricle to the abdominal Aorta , is
  displayed. The aortic arch has regular diameter
  with 3 vessels of the head and neck .

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Ductal arch view

• Ductal arch takes a trajectory that is
  practically rectilinear , anteroposterior
  ,beginning in the retrosternal region with a
  ductal arch of an obtuse angle.

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A FAST GLANCE

• Before going into the details of the examination
  we begin by taking a quick preliminary look round
  the entire area .
• We move up wards perpendicular to the axis of the
  spine towards the cephalic pole , beginning from
  the transverse abdominal view ,and the pass to
  the 4 chamber view , and then beginning of the
  aorta and pulmonary trunk .
• Continuing the movement , we see the horizontal
  portion of the aortic arch and 3 vessel view.