The fetal heart is considered to be the most important and difficult part of fetal examination. This practical and emphatically clinical book and the DVD that comes with it enable the reader first to determine whether the heart is normal or not, and then, if not, to diagnose the type of cardiac abnormality. To provide the skills and methodology to do this, the book covers basic anatomy and embryology and explains what to look for, as well as why and how. It also describes associated pathology (e.g. chromosomal abnormalities, syndromes), which the sonographer must know once a cardiac abnormality has been found.
Here is what you will find in this powerful combination of book and DVD:
Why Fetal Heart Ultrasound?
Introduction. General principles. Review. Application to fetal cardiopathies. References.
Technical Aspects
Physical principals of ultrasound applied to fetal ultrasound. Reflection of ultrasound waves. The shortest pathway. Getting around obstacles. From the point of view of time. Physical principles of Doppler. New techniques linked to volume acquisition. Practical controls. Elements to set permanently. Zoom. Focus. Gain. Preset elements. Dynamic range. Frequency. Beamline density. Persistence. Contours. Doppler settings. The size of the box. The incident wave direction. PRF. Color gain. Using ultrasound to examine the fetal heart. Echostructure. Fetal heart position. Movements of the target. Technical pitfalls. Problems linked to exposure in the zone of interest. Ultrasound windows. Setting pitfalls. Further reading.
Correlating the Ultrasound Image with the Anatomy
Three steps, 10 key points: First step: Position. Key points: Lateralization, organs, vessels, the axis of the heart. Second Step: Inflow. Key points: Heart, diaphragm, and pulmonary veins; 4 chambers; contractile, balanced, concordant; crux-of-the-heart, rings, and offsetting. Third Step: Outflow. Key points: 2 balanced outlet chambers with the alignment of the septum, 2 superimposed and crossed arched vessels; balanced and concordant. Regular aortic arch. References.
Conducting the Examination and Avoiding Pitfalls
Taking the history. A fast glance. Views verifying the 10 key points and their pitfalls. The lift, verification of the position, and pitfalls. Technique and pitfalls: elements of lateralization, organ position, vessel position. The four chamber view: inlet verification and its pitfalls. The technique. Axial apical pathway. Crux-of-the-heart. Pitfalls. The Ao and apex of the heart on the same side to the left. The heart's axis. The swings. Lateral fluctuation: asymmetries. Anterior-posterior movements: false AVSD and false VSD. View LV-aorta. Axial-apical view. Axial lateral view. "SOS" view: Sagittal and its pitfalls. View RV-PT. Axial view. Small axis view and its pitfalls. The 3 vessel or 2 arches view. Pitfalls. Sagittal view and the aortic arch. Pitfalls. Further Reading. References.
Critical Cardiac Pathologies Not To Be Overlooked
First step: Position pathologies. Key points: Position anomalies of the organs, of situs; vessel position; anomalies of the position of the heart; in the right thorax; heart axis. Second Step: Inlet pathologies. Key points: Anomalies of pulmonary venous return; irregular number of chambers (3, 4+ or 5 chambers); unbalanced; abnormalities of the atrioventricular valves (atresia of one AV valve and the spectrum of AVSD). Third Step: Outflow pathologies. Key points: VSD misalignment in CTC, complete transposition of the great vessels, hypoplasia of the left tract, ventricular-arterial discordances and position errors, coarctation of the aorta, interruption of the aortic arch. References.
Fetal Morphological Examination after the Discovery of a Cardiopathy
Unknown karyotypes. Investigation for signs associated with the principal chromosomal anomalies. Normal known karyotype. Investigation of a microdeletion 22 q11 or signs linked with associations or genetic syndromes. Cardiopathy and intrauterine restricted growth (IURG). Fetal alcohol syndrome. VACTERL syndrome. References.
Points to remember
Technical points. Key points in the heart exam. Morphology. Further Reading.
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