4 chamber view of Heart

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Basics of 4 chamber view of the heart

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4 chamber view of Heart

  1. 1. Normal Four Chamber View Dr.Sameer Dikshit MD DGO FCPS FICOG
  2. 2.  Nowrosjee Wadia Maternity Home BSES MG Hospital S L Raheja-Fortis Hospital
  3. 3.  Approximately 8 per 1000 live births ◦ 3 times more common than identifiable chromosomal disease ◦ 4 times more common than neural tube defect
  4. 4. 4 Chamber view of the fetalheart
  5. 5. Advantages Easy to obtain Move up from AC view Easy to identify
  6. 6.  Easy to standardize Can be easily included in mid trimester scan protocol without incurring additional expense/ time/ personnel
  7. 7.  Axis Size Pericardial effusion 2 Atria roughly equal
  8. 8.  2 Ventricles roughly equal AV valves with offset IVS
  9. 9.  Inter- atrial septum with foraminal flap Pulmonary veins A & V rhythm Colour Doppler for flow across the AV valves
  10. 10. #1) Determine SitusStomach tothe left side& Liver to theright SitusSolitus
  11. 11. #2) Position of the HeartAll of theheart except abit of RA lie inthe Left Half
  12. 12. #3) Axis450 +/- 150Apex Pointingto the LeftLevocardia
  13. 13. #4) 4 Chamber ViewAnatomicalv/sMorphological
  14. 14. #5) AV valvesOffsetTricuspid isapical thanMitral
  15. 15. #6) IVS & IASSeptum PrimumSeptum Secundum
  16. 16. #7) Heart Rate and Rhythm-1M Mode
  17. 17. #8) Heart Rate and Rhythm-2Pulsed WaveDoppler
  18. 18. #9) Colour Doppler 12 streamsfrom A to V
  19. 19. #10) Colour Doppler 2Aortic outflow
  20. 20. #11) Pulm VeinsPV open intoLA
  21. 21. #12) PV pulsed wavedoppler
  22. 22. #13) Foramen OvaleFlow
  23. 23. #12) Lateral 4 chamber viewGood view ofIVS
  24. 24. #13) Lateral 4 chamber colour DopplerColourDoppler formuscular VSD
  25. 25. #14) First TrimesterHeart-1
  26. 26. #15) First TrimesterHeart-2
  27. 27. #15) First TrimesterHeart-3
  28. 28. CHDs associated withabnormal 4 Ch view Abnormal Situs Inequality of chambers ◦ Hypoplastic Right/ Left Heart syndrome Septal defects ◦ Large VSD ◦ AVSD Valvular abnormalities
  29. 29. CHDs associated withabnormal 4 Ch view..contd. Severe abnormalities of vessels ◦ Coarctation of aorta/ aortic stenosis ◦ Pulmonary stenosis Pericardial effusion Myocardial hypertrophy Cardiac Tumours
  30. 30. “Is 4 chamber view a goodscreening test ?”
  31. 31.  Only 40% of CHD can be diagnosed with 4 Ch view Various studies quote a range from 15-60%
  32. 32. Screening Test DRRisk Factors approach 11%4 Chamber View 40%
  33. 33. Why 4 Ch view fails?
  34. 34. CHDs NOT associated withabnormal 4 CH view1. Abnormalities of great vessels not associated with any defect on cardiac chambers2. CHDs with progressive evolution3. CHDs not detectable in utero
  35. 35. (1) Abnormalities of great vesselsnot associated with effect onchambers  Mild Aortic stenosis, Coarctation  Tetralogy of Fallot of aorta , Pulmonary stenosis  Transposition of great vessels  Double outlet ventricle  Truncus Arteriosus  Pulmonary atresia with VSD
  36. 36. (2)CHDs with progressiveevolution Pulmonary stenosis Aortic Coarctation Ventricular hypoplasia
  37. 37. (3)CHDs NOT detectable inutero  Isolated ASD  (Postnatally) Patent ductus  Small VSD arteriosus  Partial anomalous pulmonary venous  (Postnatally) connection Patent foramen ovale
  38. 38. Can we do something to improve thepick up rate of 4- chamber view??
  39. 39. Inadequate examination Heart is examined at inappropriate angle Maternal Habitus “Lack of time” Sub-Optimal magnification
  40. 40.  Heart fills 1/3 to ½ of the screen
  41. 41.  Introduce protocol of measuring ventricles in systole and diastole Many times the 4 chamber view of the heart may “look normal” but the measurements may be outside the normal limits
  42. 42.  Use cine loop to see the heart in all phases of cardiac cycle
  43. 43.  Use colour doppler and PW doppler
  44. 44. Pitfalls in 4 chamber view My Experience
  45. 45. Case #1 Extra vessel noted while moving up from AC view
  46. 46. Aorta far offfrom LA
  47. 47. Leash ofvesselsbehind LA
  48. 48. Anomalous PulmonaryVenous Return Schimitar vessel
  49. 49. Case #2
  50. 50. Hypoplastic Left Heart Poor flow across Mitral Valve
  51. 51. Case #3
  52. 52. Ebstein’s
  53. 53. AVSD
  54. 54. Septum Primum ASD
  55. 55. Case#4
  56. 56. Perimembranous VSD
  57. 57. Perimembranous VSD
  58. 58. Rt Aortic Arch
  59. 59. Abnormal 4 chamber views Fetal Medicine Foundation videos
  60. 60. Ventricular Septal Defect
  61. 61. Atrio Ventricular SeptalDefect
  62. 62. Tricuspid Regurgitation
  63. 63. Ebstein’s Anomaly
  64. 64. BiventricularRegurgitation
  65. 65. Corrected Transposition
  66. 66. CongenitalDiaphragmatic Hernia
  67. 67. Rhabdomyomas
  68. 68. Dextrocardia
  69. 69. Anemia
  70. 70. Take home message
  71. 71.  What is 4 chamber  Pick up rate view  Why 4 chamber What structures to view fails see in 4 chamber view  Abnormal 4 chamber view examples

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