ISUOG Basic Training. Obtaining & Interpreting Heart Views Correctly Alfred Abuhamad, USA. Basic training. Editable text here
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1 ISUOG Basic Training Obtaining & Interpreting Heart Views Correctly Alfred Abuhamad, USA
2 Learning Objectives 6, 7 & 8 At the end of the lecture you will be able to: describe how to assess cardiac situs describe the key features of the 4 planes required to assess the fetal heart correctly
3 Key Questions What are the key ultrasound features of plane 7? What probe movements are required to move through the 4 cardiac planes correctly? What are the key ultrasound features of plane 10?
4 Ultrasound Obstet Gynecol 2013; 41:
5 7: Four-Chamber View
6 8: Left Ventricular Outflow
7 9: Right Ventricular Outflow
8 10: Three-Vessel-Trachea
9 7: Four-Chamber View -Fetal laterality (identify right and left sides of fetus) -Stomach and heart on left
10 Normal Situs Abdominal Circumference
11 Normal Situs - Chest Ao Practical Guide To Fetal Echocardiography Abuhamad, Chaoui 2 nd Edition
12 Types of Fetal Situs
13 Types of Fetal Situs Situs Incidence CHD Solitus Common Not Increased Inversus * 1/100 Slightly Increased (0.3 5%) Ambiguous 1/10,000 Increased *: Kartagener syndrome in 20%
14 Left Isomerism Practical Guide To Fetal Echocardiography Abuhamad, Chaoui 2 nd Edition
15 Right Isomerism Practical Guide To Fetal Echocardiography Abuhamad, Chaoui 2 nd Edition
16 7: Four-Chamber View -Fetal laterality (identify right and left sides of fetus) -Stomach and heart on left -Heart occupies a third of thoracic area -Majority of heart in left chest
17 Heart Size
18 Cardiac Position L 2/3 1/3 R
19 Cardiac Position
20 7: Four-Chamber View -Fetal laterality (identify right and left sides of fetus) -Stomach and heart on left -Heart occupies a third of thoracic area -Majority of heart in left chest -Cardiac axis (apex) points to left by 45 ± 20
21 Cardiac Axis L LV RV
22 Cardiac Axis Data From Normal Fetuses (n=183) Axis at around 45% Range Axis at of around normal 45% +/- 20 degrees No Range change of normal with gestation +/- 20 degrees No change with gestation Obstet. Gynecol. 1987;70:1987
23 Left Axis Deviation Abnormal Cardiac Axis Most abnormal cardiac axis are left axis deviations Most are diagnosed in second trimester Obstet. Gynecol. 1995;85:97
24 Cardiac Axis CAT TGA TOF DORV
25 7: Four-Chamber View -Fetal laterality (identify right and left sides of fetus) -Stomach and heart on left -Heart occupies a third of thoracic area -Majority of heart in left chest -Cardiac axis (apex) points to left by 45 ± 20 -Four chambers present
26 Four-Chamber View Apical
27 Four-Chamber View Axial
28 Four-Chamber View Basal
29 Atrial Chambers -Two atria, approximately equal in size -Foramen ovale flap in left atrium -Atrial septum primum present (near to crux) -Pulmonary veins entering left atrium Ultrasound Obstet Gynecol 2013; 41:
30 Left Atrium
31 Left Atrium Ao
32 7 Left Atrium
33 Pulmonary Veins
34 Left Atrium Closed Esophagus Open Esophagus
35 Left Atrium TAPVR From Practical Guide To Fetal Echocardiography: Normal & Abnormal Hearts Abuhamad, Chaoui 3 rd Edition
36 Right Atrium RA From Practical Guide To Fetal Echocardiography: Normal & Abnormal Hearts Abuhamad, Chaoui 3 rd Edition
37 Right Atrium From Practical Guide To Fetal Echocardiography: Normal & Abnormal Hearts Abuhamad, Chaoui 3 rd Edition
38 Right Atrium
39 Interatrial Septum L LV LA RV RA
40 Ventricular Chambers -Two ventricles, approximately equal in size -No ventricular wall hypertrophy -Moderator band at right ventricular apex -Ventricular septum intact (apex to crux) Ultrasound Obstet Gynecol 2013; 41:
41 Right Ventricle From Practical Guide To Fetal Echocardiography: Normal & Abnormal Hearts Abuhamad, Chaoui 3 rd Edition
42 Right Ventricle
43 Right Ventricle LV RV LV RV
44 Right Ventricle
45 Left Ventricle From Practical Guide To Fetal Echocardiography: Normal & Abnormal Hearts Abuhamad, Chaoui 3 rd Edition
46 Left Ventricle
47 Left Ventricle
48 Ventricular Septum
49 Ventricular Septum
50 Ventricular Septum Muscular
51 Ventricular Septum Perimembranous
52 Atrioventricular Junction & Valves -Intact cardiac crux -Two atrioventricular valves open and move freely -Differential offsetting: tricuspid valve leaflet inserts on ventricular septum closer to cardiac apex than does mitral valve Ultrasound Obstet Gynecol 2013; 41:
53 Atrioventricular Valves
54 Atrioventricular Valves
55 7: Four-Chamber View -Fetal laterality (identify right and left sides of fetus) -Stomach and heart on left -Heart occupies a third of thoracic area -Majority of heart in left chest -Cardiac axis (apex) points to left by 45 ± 20 -Four chambers present -Regular cardiac rhythm
56 Regular Cardiac Rhythm
57 7: Four-Chamber View -Fetal laterality (identify right and left sides of fetus) -Stomach and heart on left -Heart occupies a third of thoracic area -Majority of heart in left chest -Cardiac axis (apex) points to left by 45 ± 20 -Four chambers present -Regular cardiac rhythm -No pericardial effusion
58 Four Chamber View
59 Four-Chamber View From Practical Guide To Fetal Echocardiography: Normal & Abnormal Hearts Abuhamad, Chaoui 3 rd Edition
60 From Practical Guide To Fetal Echocardiography: Normal & Abnormal Hearts Abuhamad, Chaoui 3 rd Edition
61 8: Left Ventricular Outflow
62 Left Ventricular Outflow
63 Left Ventricular Outflow
64 Left Ventricular Outflow
65 Left Ventricular Outflow Normal TOF
66 Left Ventricular Outflow TOF
67 Left Ventricular Outflow TOF
68 Left Ventricular Outflow
69 Left Ventricular Outflow
70 Left Ventricular Outflow
71 Left Ventricular Outflow
72 Left Ventricular Outflow
73 Left Ventricular Outflow Mitral - aortic continuity Aorta within left ventricle Angle of ascending aorta with ventricular septum Aorta does not divide Close observation of aortic valves
74 9: Right Ventricular Outflow
75 Right Ventricular Outflow
76 Right Ventricular Outflow
77 10: Three-Vessel-Trachea
78 Three-Vessel Trachea 79
79 Three-Vessel Trachea 80
80 Three-Vessel Trachea 81
81 Three-Vessel Trachea 82
82 Three-Vessel Trachea 83
83 Three-Vessel Trachea 84
84 Three-Vessel Trachea Blood flows towards the spine 85
85 Three-Vessel Trachea Spine 86
86 Checklist Three-Vessel-Trachea Course & size of PA, Ao & SVC Thymus present Course & size of DA & Ao Isthmus Flow assessment by color Doppler Ao arch & DA right or left sided Presence of atypical vessels LSVC TAPVR
87 TGA HLHS RAA IAA TOF
88 Three-Vessel Trachea 89
89 Three-Vessel Trachea Abnormal in: HLHS HRHS TGA DORV TOF CAT TAPVR PA-VSD PS / PA Critical Ao Stenosis Coarctation of Ao ARSA LSVC TA-VSD RAA Double Ao Arch Ebstein Interrupted Ao Arch Courtesy of Dr. Chaoui 90
90 Conclusion Normal situs Normal axis Ventricles equal in size and contractility LVOT arises with an angle LVOT does not divide Normal valves PA anterior PA and Ao same size Normal valves 3 vessels seen Ao and PA normal size DA & Ao Arch to left of trachea
91 Free Download 92
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