The Fetal Heart: Standpoint of the General Sonographer

and Marcelo Zugaib4



(1)
São Paulo University, Bauru, Brazil

(2)
Parisian University, Bauru, France

(3)
Member of International Fetal Medicine and Surgery Society, Bauru, Brazil

(4)
Obstetrics, University of São Paulo, Bauru, Brazil

 



Fetal cardiac abnormalities are examples of how prenatal diagnosis can be useful in a case of fetal malformation, being extremely beneficial to the couple and especially to the conceptus. The frequency of fetal cardiac abnormalities is substantial (around 0.8%) and most of them can be diagnosed during the prenatal period.

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Fig. 6.1
Transverse view of the fetal thorax showing the normal four-chamber view. The fetal back is in the right and posterior position, and the right chambers are in a superior position. The arrow shows the interventricular septum with no defect; the septum should be analyzed in this view. Note the proximity of the left ventricle (VE) and the spine (S). VD = right ventricle, LA = left atrium, RA = right atrium, A = descending aorta


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Fig. 6.2
A four-chamber view showing the unbalanced dimension of the chambers, with dilation of the left atrium


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Fig. 6.3
Four-chamber view with a small left atrium and left hypoplastic ventricle. This is an absolute indication for fetal echocardiography


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Fig. 6.4
Four-chamber view showing asymmetric chambers because of dilatation of the left chambers (LV and LA) in a fetus at 35 weeks. The interventricular septum has no defects and the mitral and tricuspid valves are well positioned. RA = right atrium, VD = right ventricle, S = spine


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Fig. 6.5
Transverse view of the fetal thorax showing the cardiac base. The fetal back is anterior and on the right. Observe the mitral valve (M) insertion above the tricuspid valve insertion (T). Also observe the proximity of the left atrium and the descending thoracic aorta (A). This does not change regardless of the incidence


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Fig. 6.6
Four-chamber view showing the open valves (mitral and tricuspid) and the oval foramen (OF). C = spine


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Fig. 6.7
Transversel section (four chamber view) showing the normal position oval foramen valve at the left atrium (arrow)


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Fig. 6.8
Trasnsvaginal scan of a normal fetal heart at 15 weeks gestation. Notice the normal four chamber view and the integrity of interventricular septum (S)


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Fig. 6.9
Four-chamber view in a fetus at 19 weeks showing the interventricular septum with no defect (arrow) and the normal position of the mitral (M) and tricuspid (T) valves


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Fig. 6.10
Longitudinal view of the heart showing the aorta (arrows) arising from the left ventricle (VE). VD = right ventricle


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Fig. 6.11
The crossing over of the great vessels in a 26-week-old fetus. The aorta (Ao) on the left side arising from the left ventricle (VE) and the pulmonary artery (Ap) arising from the right ventricle (VD) on the right side. Observe the matching valves (arrows)


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Fig. 6.12
The aortic outlet view, obtained with a “lock and key” movement starting in the four-chamber view. In this view, the continuity of the mitral valve with the aorta should be checked, along with the integrity of the septum (excluding outlet interventricular communication)


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Fig. 6.13
The figure shows the normal crossing of pulmonary artery and aorta. On the left one can see the pulmonary artery (AP) exiting from de right ventricle (VD) and, on the right, the aorta (AO) is shown coming out of the left ventricle (VE) with a typical cross figure


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Fig. 6.14
A transverse plane, above the four-chamber view, is the three-vessel view. This view cannot be obtained in cases of transposition of the great vessels. The correct diameter of these vessels also gives a good indication of normality. VC = vena cava, AO = aorta, PA = pulmonary artery


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Fig. 6.15
Pulmonary artery trunk. A transverse view of a cardiac base showing the pulmonary artery trunk arising from the right ventricle and its bifurcation in the left (LPA) and right (RPA) pulmonary arteries. The ascending and descending aortic artery next to the spine always appears in this view

Dec 28, 2017 | Posted by in GYNECOLOGY | Comments Off on The Fetal Heart: Standpoint of the General Sonographer
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