《胎儿的循环系统(英文版)课件》由会员分享，可在线阅读，更多相关《胎儿的循环系统(英文版)课件（73页珍藏版）》请在金锄头文库上搜索。
1、Fetal CardiologyKottler NE, Leopold GR, OBoyle M, Pretorius D, Sirlin CBFetal CardiologyCardiac anomalies are the most frequently overlooked group of abnormalitiesCongenital heart disease = 0.8% of all pregnancies4% one sibling affected; 10% two siblings affected9% father affected12% mother affected
2、Causes 50% deaths from congenital diseaseFetal CardiologyRisk Factors for congenital heart disease: Family history Recurrence risk (hypoplastic left heart as high as 13.5%) Nongestational DM Maternal infection (rubella) Lupus Drugs (anticonvulsants, etoh, amphetamines, ocp, vit A, steroids, etc.)Fet
3、al CardiologyAIUM / ACR standards in the 2nd and 3rd trimesters include: Four chamber view Position of fetal heart in the thorax LVOT and RVOT not yet part of standards4 chamber view alone: 33-63% sensitiveWith outflow tracts: 83-85% sensitive 2GOALSReview normal cardiac anatomy and its sonographic
4、appearance (four chamber, LVOT, RVOT)Explore diagnostic pitfallsReview the appearance of more common structural cardiac defectsThe Four Chamber View1.Heart fills one third of the chestThe Four Chamber View2.Apex points to the left (45 degree angle)The Four Chamber View3.Size of right chambers approx
5、imates left chambersThe Four Chamber View1.MV and TV move on real time imaging4.Ventricular septum symmetricThe Four Chamber View6.Portion of the atrial septum present (crus)Left Ventricular Outflow TractIdentify: LV, RV, IV septum, aorta (normal caliber), +/- LA, +/- RAMedial wall of the ascending
6、aorta merges with the top of the IV septum (most frequent location for VSD)Pathology: VSD, tetralogy of Fallot, transposition, truncus arteriosusRight Ventricular Outflow TractIdentify: branching of the main PA into right PA and ductus arteriosus (to desc Aorta), asc aorta in cross section, desc aor
7、ta to left of spine; verify PA crosses anterior to asc aortaPathology: transposition, truncus arteriosusSpineSpLeft AtriumRight AtriumLeft VentricleRight VentricleModerator BandForamen OvaleFour ChamberInterventricular SeptumLeft AtriumLeft VentricleRight VentricleAortaMitral Valve (closed)Aortic Va
8、lve (open)Interventricular SeptumLeft Ventricular Outflow TractRight Ventricular Outflow TractRight AtriumRight VentricleMain Pulmonary ArteryRight Pulmonary ArteryDuctus ArteriosusAscending AortaAoTricuspid ValvePulmonic Valve (open)Descending AortadAoSpPitfalls: PseudoVSDWhen the IV septum paralle
9、ls the US beam, resultant echo drop out looks like VSDIV septum normally tapers near the AV valvesCorrected by changing the angle of viewIV septum parallels US beam (echo dropout)Changing Angle Pericardial effusion ? NO! Normal amount fluid ( PATetralogy of FallotvideoCourtesy of Dr Alfred Albahamed
10、click image to play video Endocardial Cushion Defect5% of CHD Recur risk = 3% (1 sib), 10% (2 sibs), 1% (dad), 14% (mom)Freq assoc with other anomalies; strong assoc with Trisomy 21Large defect at the crus of heart on four chamber viewEndocardial Cushion DefectSeveral types depend on how AV valves a
11、ttach. Most common is type III, complete AV canal and common AV valveEndocardial cushions fail to fuse; cause defect in both the atrial and ventricular septae (AV canal)Endocardial Cushion DefectatriaventsEndocardial Cushion Defect 4 Chamber ViewEndocardial Cushion Defect 4 Chamber ViewCourtesy of D
12、r Mark SkalanskyEndocardial Cushion DefectatriaventsEndocardial Cushion DefectventsatriaEndocardial Cushion Defectvideoclick image to play videoTransposition of Great VesselsD-type (“complete”) = heart tube loops to the right normal orientation of ventricles; but vessels malform (cyanosis)L-type (“c
13、ongenitally corrected”) = heart tube loops to the left ventricular inversion, but normal vessel orientation (no cyanosis)Childrens Virtual HospitalTransposition of the Great Vessels4-6% of CHDRecurrence risk = 1.5% (1 sib), 5% (2 sibs)Association with excessive vitamin ARarely associated with chromo
14、some abnormalities 4Transposition Great VesselsVSD (30-50%)Aorta arises anterior and to the right of PA; great vessels parallel each other5 year survival (surgery) 90%Transposition Great VesselsCourtesy of Dr Mark SkalanskyTransposition Great VesselsvideoCourtesy of Dr Alred Albafamedclick image to
15、play video (video starts slowly)Hypoplastic Left Heart2-4% of CHD 3Hypoplasia of the LV; MV / AV stenosis or atresiaAssoc with coarctation of aorta (80%) when AV atreticHypothesis: low blood flow to LV causes hypoplasiaHypoplastic Left HeartCauses hypoperfusion of coronary arts; CHF from ischemiaCya
16、nosis at birth if LA to RA shunt not adequateAssociated with chromosomal anomalies = 16% (one half from Trisomy 18 alone) 4 Hypoplastic Left Heart4 Chamber ViewHypoplastic Right HeartUnderdevelopment of right sided heart structuresHypoplasia of the RV and PA; RV wall thick; hypoplastic or incompeten
17、t TV; PV atresiaRelies on patent ductus arteriosus for blood supply to lungs (PGE1)Tx = surgical sytemic to pulmonary shunt (Blalock Taussig Shunt) Hypoplastic Right HeartSmall RV, thick wallHypoplastic Right HeartSmall RVNotice themoderator bandHypoplastic Right Heart RVOT LVOTCaliber of PA aortaDo
18、uble Outlet Right Ventricle1% of CHDRecurrence risks not definedBoth PA and at least half of the aorta originate from RVKaryotype abnormalities = 5%; including Trisomy 13,18 4Double Outlet Right VentricleAssociated with VSD, ascending aortic stenosis, pulmonic stenosis, AV abnormalitiesComplex embry
19、ologic changes involving bulbus cordis (RV), conus cordis (septum), and truncus arteriosus (great vessels)Double Outlet Right VentricleBoth the PA and aorta (more than 50%) arise from the RVDouble Outlet Right Ventriclevideoclick image to play videoTruncus Arteriosus1% CHDSingle arterial vessel “tru
20、ncus” arises from the heart and supplies the coronary arteries, pulmonary and systemic circulations Recurrence risk = 1% (1 sib), 3% (2 sibs) 4Truncus ArteriosusOther associated pathology: VSD, abnormal trucal valve, ASD20% overall mortality (surg 6mo to avoid pulmonary HTN)Differentiate from tetral
21、ogy of Fallot = no RVOT; look for origin of PAs from truncusTruncus ArteriosusTruncus ArteriosusTruncus ArteriosusFour Types (Van Praagh Classification)1.Main PA arises from truncal root and divides2.Both PAs arise from the truncal root separately3.Left PA supplied by collaterals from aortic arch4.A
22、ortic arch interrupted; desc aorta supplied by ductus (10-15%)Ebstein Anomaly1% CHDRecurrence risk = 1% (1 sib), 3% (2 sibs)Apical displacement of TV; small RV; RA grossly dilated because TV incompetentEbstein AnomalyAssoc with ASD, WPW syndrome (30%), RV outflow obstruction (PS); CHF in utero from
23、TR 1Surgery to replace TV 1 ; arrhythmia is frequent after correction (dilated RA)Ebstein Anomaly4 Chamber ViewTVEbstein AnomalyCourtesy of Dr Mark SkalanskyEbstein AnomalyCourtesy of Dr Alfred Albafamedclick image to play videoCoarctation of Aorta 2 / 1 (normal 1.8 / 1)Assoc w/ other cardiac defect
24、s = bicuspid aortic valve, VSD, ASD10% association with chromosomal anomalies (especially Turners)Coarctation of AortaCoarctation of Aortavideoclick image to play videoReferences1.Diagnostic Ultrasound of Fetal Anomalies: Text and Atlas, Nyberg DA, Mahony BS, Pretorius DH, 1990, Year Bood Medical Pu
25、blisher, Inc.2.Sonography of the Normal Fetal Heart: A Practical Approach, Frates MC, AJR 1999; 173: 1363-70.3.Prenatal Diagnosis of Congenital Cardiac Anomalies: A Practical Approach Using Two Basic Views, Barboza JM, Dajani NK, Glenn LG, Angtuaco Tl, Radiographics 2002; 22: 1125-1138.4.Structural
26、Fetal Abnormalities: The Total Picture, Rodger C Sanders et al, 2nd edition, 2002 Mosby, Inc.References5.Fetal Echocardiography: An Atlas, Kathryn L Reed, Caroline F anderson, Lewis Shender, 1988 Alan R Liss, Inc, NY, NY.6.Color Atlas of Fetal Cardiology, Lindsey Allan, Gurleen Sharland, Andrew Cook, 1994 Mosby Wolfe Publishing.7.Significance of Fetal Intracardiac Echogenic Foci in Relation to Trisomy 21: A prospective Sonographic Study of High Risk Pregnant Women, Manning JE, Ragavendra N, Sayre J, Laifer-Narin SL, Melany ML, Grant EG, Crandall BF, AJR 1998; 170: 1083-4.THANK YOU !
