Fetal Ecocardiography Screening

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Case of CHD at 12-14 weeks, with Tricuspid regurgitation at nuchal scan.
At 8/9 weeks heart position looks like "ecttopia cordi" (sorry for absent avi. where everything can see)

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Fetal Ecocardiography Screening

  1. 1. Pr enataldia gnosis of fetalhear t anomalies Ultrasound screening Bogdan M. Muresan
  2. 2. The incidence of CHD (Congenital HeartDisease) is around 8 to 9 per 1000 livebirths  If all subtle cardiac anomalies are counted (bicuspid Ao valve, aneurysm of atrial septum and LSVC persistent) may be in order of 50 per 1000 live births.  The suspicion for CHD during a routine ultrasound is a risk factor with highest yield for CHD (40 to 50%)
  3. 3. The majority of fetuses with CHD have no knownrisk factors.SCREENING for CHD to every pregnant women -routine scan: nuchal scan (12 weeks) andanomalies scan (20-22 weeks) Risk factors for CHD  Fetal: chromosomal abnormalities, extracardiac anatomic abnormalities, fetal cardiac arrhytmia, suspected cardiac anomaly on routine ultrasound, thickened nuchal translucency, monochorionic placentation;  Maternal: family history of CHD, maternal metabolic disorders (diabetes, phenylketonuria), maternal teratogen exposure, pregnancy from assisted reproduction techniques, maternal obesity  Alferd Abuhamad, Rabih Chaoui: A Practical Guide to Fetal Echocardiography
  4. 4. Nuchal scan (11-13WG)soft markers for aneuploidies and CHD (in euploid cases): NT thickened; TR regurgitation; DV with “a” reverse
  5. 5. CASE: 8 weeks pregnancy - refferal for a “problem”?
  6. 6. Is here a normal pregnancy ???
  7. 7. Routine exam at 8 weeks search for: localisation / number of fetus-placenta(intrauterine pregnancy), presence of FHR (normal FHR), embryon adnexa (normalyolk sac)
  8. 8. Is there a possible problem ?
  9. 9. Embryo anatomy: heart is almost completedeveloped; but it is impossible to assesheart anatomy- look to heart position in thorax??
  10. 10. Untill 10-11 weeks there is a normal exomphalos (with bowel contents)
  11. 11. Transverse view of embryo thorax
  12. 12. “ Ectopia cordis” ????
  13. 13. http://www.sonoworld.com/TheFetus/page.aspx? id=2687
  14. 14. Patient was reevaluated at 11 weeks (nuchal scan)unfortunately CRL < 45 mm (42,2mm) but:……
  15. 15. Normal fetal anatomy at this age
  16. 16. 3D image revealed normal fetal anterior wall(there is no place for “ectopia cordis”)
  17. 17. Nuchal scan(CRL between 45-84 mm or 11-13 WG)Normal midsagital view – fetal profile (NT, FMFangle, nasal bone, intracerebral translucency)
  18. 18. Normal fetal anterior wall: umbilical cord insertion and heart localisation
  19. 19. Good result at nuchal scan: PAPP-A, freeBetaHCG, NT Combined risk assessment (risk forchromosomal abnormalities under 1/1000)
  20. 20. New soft markers in nuchal scan: nasalbone, FMF angle, Tricuspid and DV flow(routinely)The presence of Tricuspid regurgitation –it is associated with chromosomalabnormalities and high risk for CHD ineuploid fetuses)
  21. 21. Possible AVSD(if it is present - increases T21 riskto ¼ and karyotyping is necessary)
  22. 22. After 10 days we performed a fetal echocardiography AVSD ???
  23. 23. or Mitral atresia with VSD
  24. 24. Great vessel outflow tract ???
  25. 25. Outflow Tract:- Ao and Pulmonary Trunk have common origin in RightVentricle- They are parallel at origin- Pulmonary Trunk smaller than Ao
  26. 26. DORV (VSD included) withmitral atresia/stenosis (or AVSD) and Pulmonary stenosis (possible ?)
  27. 27. DORV diferential diagnosis: conotrunkal anomalies
  28. 28. Extracardiac anomalies - ventriculomegaly
  29. 29. Management We offer karyotyping (CVS or  If karyotype is normal: amniocentesis)  search for 22q11 because it is frequent microdeletion (di associated with George) chromosomal abnormalities –  Cardiologist solution T13,18). Poor (search for real CHD at prognosis: 18-20 weeks and extracardiac anomalies prognosis depends on possible Abnormal karyotype: lesions/extracardiac we offer TOP anomalies
  30. 30. “ Ultrasound anomaliesscan” at any pregnancyages ?  Patient was referred for other reason (in this case)  Look and question for every possible anomalies  Have always suspicions  To recognize the limits of ultrasound to asses fetal anatomy at every age of gestation
  31. 31. Multumesc!T hank you!www.medicinafetala.ro

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