September 28-30, 2018 Course Director
Optimizing Detection of Congenital Heart Disease: Important Anatomic Cardiac Regions The Top 5 Critical Anatomic Regions in Fetal Cardiac Imaging Alfred Abuhamad, M.D. Eastern Virginia Medical School Top Critical Anatomic Regions eft Atrium 1. Normal eft Atrium 3 eft Atrium Pulmonary Veins! Ao 1
Pulmonary Veins 7 eft Atrium eft Atrium eft Atrium Ao A Ao A Esophagus Swallowing Closed Esophagus Open Esophagus TAPVR TAPVR Supracardiac From Practical Guide To Fetal Echocardiography: Normal & Abnormal Hearts Abuhamad, Chaoui 3 rd Edition -Oct 2015 2
7 TAPVR Cardiac TAPVR Infracardiac From Practical Guide To Fetal Echocardiography: Normal & Abnormal Hearts Abuhamad, Chaoui 3 rd Edition -Oct 2015 eft Atrium eft Atrium TAPVR From Practical Guide To Fetal Echocardiography: Normal & Abnormal Hearts Abuhamad, Chaoui 3 rd Edition -Oct 2015 TAPVR eft Atrium TAPVR AO Azygos AO Normal TAPVR J Ultrasound Med 2014; 33:1193 1207 18 3
TAPVR Do Not Miss The Diagnosis of a Normal eft Atrium 19 From Practical Guide To Fetal Echocardiography: Normal & Abnormal Hearts Abuhamad, Chaoui 3 rd Edition -Oct 2015 20 Top Critical Anatomic Regions eft Ventricular Outflow 1. Normal eft Atrium 2. Normal eft Ventricular Outflow 21 eft Ventricular Outflow eft Ventricular Outflow Normal TOF 4
eft Ventricular Outflow eft Ventricular Outflow TOF TOF eft Ventricular Outflow eft Ventricular Outflow eft Ventricular Outflow eft Ventricular Outflow From Practical Guide To Fetal Echocardiography: Normal & Abnormal Hearts Abuhamad, Chaoui 3 rd Edition -Oct 2015 5
10 TGA: eft Ventricular Outflow 10 TGA: eft Ventricular Outflow 10 TGA: eft Ventricular Outflow 10 TGA: eft Ventricular Outflow 10 ansposition of Great Arteries 10 ansposition of Great Arteries V 6
10 ansposition of Great Arteries Overall rate of detection 23 % Ultrasound Obstet Gynecol 2015; 45: 678 38 Normal eft 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 Do Not Miss The Diagnosis of a Normal eft Ventricular Outflow 40 Top Critical Anatomic Regions Normal Semilunar Valves 1. Normal eft Atrium 2. Normal Ascending Aorta 3. Normal Semilunar Valves 41 42 7
13 13 Pulmonary Stenosis Pulmonary Stenosis Pulmonary Stenosis 13 Aortic Stenosis 45 From Practical Guide To Fetal Echocardiography: Normal & Abnormal Hearts Abuhamad, Chaoui 3 rd Edition -Oct 2015 13 13 Aortic Stenosis Aortic Stenosis 8
13 Pulmonary/Aortic Stenosis Do Not Miss The Diagnosis of a Normal Semilunar Valve ook at valve echogenicity ook at valve excursion in systole (cineloop should open fully in systole) ook at wall of vessel beyond the annulus ook at color Doppler for aliasing ook at pulsed Doppler for velocity 50 Top Critical Anatomic Regions ansverse Views 1. Normal eft Atrium 2. Normal Ascending Aorta 3. Normal Semilunar Valves 4. Normal 51 Three-Vessel View Ductal Arch View 9
Aortic Arch View Three-Vessel achea View eft Brachiocephalic Vein eft Brachiocephalic Vein Thymus R Thymus AoA AoA AzV E DA R Isthmus A B 59 10
Thy-Box Sternum AoA R SP AoA AoA SP Azygos SP AoA A B R A SP B Blood Flow Towards the Spine 3VT Spine 63 11 weeks Follow the Aorta 11
13 wks Courtesy of Dr. Chaoui Checklist 3-VT-view! Course and size of, Ao and Aortic isthmus and ductus arteriosus O Aortic arch right or left-sided? (achea as landmark) Thymus Ao achea Thymus visualized Assessment with Color Doppler: Blue V or Red V Atypical vessels (left persistent - Vertical Vein) 3VT: 3 Vessels Seen 70 : 3 Vessels Seen Small Aorta Coarctation of Aorta Coarctation of the Aorta Hypoplastic eft Heart Syndrome 71 72 12
: 3 Vessels Seen Small Aorta : 3 Vessels Seen Small Hypoplastic eft Heart Syndrome Pulmonary Stenosis - TOF Pulmonary Atresia 74 TOF - Pulmonary Stenosis TOF - Pulmonary Stenosis Pink Blue TOF - Pulmonary Atresia : 3 Vessels Seen arge Dilated! Dilated, turbulent Flow! AO AO A B Absent Pulmonary Valve Syndrome 13
: 2 Vessels Seen Normal size great vessel 3VT: 2 Vessels Seen AO AO A B 79 TGA (Convex Course) : 2 Vessels Seen Normal size great vessel : 2 Vessels Seen Normal size great vessel TGA (Convex Course) TGA - Convex-shape of Aorta V A 14
TGA (atypical) VSD Normal-looking 3VT: Abnormal Course of Vessels 90 15
: 3 Vessels Seen Abnormal Vessel Course : 3 Vessels Seen Abnormal Vessel Course Normal Right Ao Arch - Right DA RAo RAo DA DA A B C Right Ao Arch - eft DA Double Ao Arch Right-Sided Aortic Arch - eft DA U-Sign, vascular ring (loose) : 3 Vessels Seen Abnormal Vessel Course : 3 Vessels Seen Abnormal Vessel Course AoA RAoA DA T A B Right-Sided Aortic Arch - eft DA U-Sign, vascular ring (loose) Double Aortic Arch : 3 Vessels Seen Abnormal Vessel Course 3VT: 4 Vessels Seen Double Aortic Arch 96 16
: 4 Vessels Seen Persistent eft Superior Vena Cava : 4 Vessels Seen Persistent eft Superior Vena Cava Ao achea achea Ao A B 98 : 4 Vessels Seen Supracardiac TAPVR : 4 Vessels Seen vs. TAPVR? Ao 4th Vessel achea Enlarged CS Ao A B Absent left BCV : 4 Vessels Seen vs. TAPVR? TAPVR CS 4th Vessel : 4 Vessels Seen DA Aneurysm/Kinking DA Aneurysm Normal CS Ao DAA dao achea aao arge left BCV From Echocardiographic anatomy in the fetus. Chiappa E.M et al. 17
: 4 Vessels Seen DA Aneurysm/Kinking HHS HRHS TGA DORV TOF CAT TAPVR -VSD Abnormal in: PS / Critical Ao Stenosis Coarctation of Ao ARSA TA-VSD RAA Double Ao Arch Ebstein Interrupted Ao Arch achea Do Not Miss The Diagnosis of a Normal Top Critical Anatomic Regions 1. Normal eft Atrium 2. Normal Ascending Aorta 3. Normal Semilunar Valves 4. Normal 5. Normal Ventricular Septum 105 106 Ventricular Septum and US Views Ventricular Septum and US Views Muscular Membranous Outlet Inlet 4-chamber view VOT view RVOT view 18
Ventricular Septum Ventricular Septum Inlet Muscular Ventricular Septum Ventricular Septum Muscular From Practical Guide To Fetal Echocardiography Abuhamad, Chaoui 2 nd Edition Muscular Ventricular Septum Ventricular Septum Muscular Perimembranous 19
Normal Ventricular Septum ook for the T sign in apical views Insonate the septum at 90 degrees for optimal diagnosis of muscular and perimembranous VSD Color Doppler confirm the diagnosis Do Not Miss The Diagnosis of a Normal Ventricular Septum 116 Top Anatomic Regions Normal left atrium: rule out TAPVR, Isomerism, Interrupted IVC Normal ascending aorta: rule out TOF, TGA, DORV Normal semilunar valves: rule out AS, PS, HHS, Normal 3VT view: rule out conotruncal anomalies, RAA, HHS, coarctation of Ao Normal ventricular septum: rule out VSD, AVSD Free Download www.openultrasound.com More than 25,000 Downloads anslated to 11 languages 118 20