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How, Why and When
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By
Catherine Fredouille, MD, Part-time Hospital Practitioner, Fetal Placentology Unit, Hopital de La Timone, Marseille. Consultant in Fetopathology, Service de
Cytogenetique et de Foetopathologie, Hopital Saint Antoine, Paris, France
Jean-Eric Develay-Morice, MD, Ultrasonographer, Nimes Maternity Service, Hopital Carremeau, Nimes, France
Included in series
How, Why and When,
Description
The fetal heart is considered to be the most important and difficult part of fetal examination. The purpose of this book and accompanying
DVD is to enable the reader firstly to find out whether the heart is normal or not, and secondly to diagnose the type of cardiac abnormality
if present. To provide the skills and methodology to do this, the book covers basic anatomy and embryology, and explains what to look
for, why and how. It also describes associated pathology (e.g. chromosomal abnormalities, syndromes) which the sonographer needs to know
after a cardiac abnormality has been found.
Contents
1. Fetal Heart Ultrasound: WHY
Introduction.
General Notions.
Review.
Application to Fetal Cardiopathies.
References.
2.
HOW: Technical Aspects
Physical principals of Ultrasound applied to fetal ultrasound.
Reflection of ultra sound 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.
The zoom.
The focus.
Gain.
Pre-set
elements.
The dynamic range.
The frequency.
Beamline density.
Persistence.
Contours.
Doppler settings.
The size
of the ?box.?
The incident wave direction.
PRF.
Color gain.
The use of Ultrasound in examining the fetal heart.
Echo-structure.
The
fetal heart position.
Movements of the target.
Technical Pitfalls.
Problems linked to exposure in the zone of interest.
Ultrasound
windows.
Setting Pitfalls.
Further Reading.
3. HOW: Anatomic – ultrasound correlations: 3 steps, 10 key points
1st
step: Position: 2 key points.
Lateralization.
Organs.
Vessels.
The axis of the heart.
2nd Step, Inflow: 4 key points.
Heart,
Diaphragm and pulmonary veins.
4 Chambers.
Contractile, balanced, Concordant.
Crux-of-the-Heart, rings and offsetting.
3rd
step, Outflow: 4 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.
4. HOW: Conducting the examination and its pitfalls
Taking
the history.
A Fast glance.
Views verifying the 10 key points and their pitfalls.
The ?lift?, verification of the position and
its pitfalls.
The technique.
Its 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.
5. WHY: Critical cardiac pathologies not to
be overlooked
1st Step: Position pathologies: 2 key points.
Position anomalies of the organs, of situs.
Vessel
Position.
Anomalies of the Position of the Heart.
In the right thorax.
Heart axis.
2nd Step: Inlet Pathologies: 4 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.
3rd Step: Outflow pathologies: 4 key points.
VSD misalignment in CTC.
Complete
transposition of the great vessels.
Hypoplasia of the Left tract, ventricular-arterial discordances and position errors.
Aortic
Coarctation of the Ao, Interruption of the Aortic arch.
References.
6. WHEN: 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 micro-deletion 22 q11 or signs linked with Associations, or genetic syndromes.
Cardiopathy
and Intra uterine retarded growth (IURG).
Fetal alcohol syndrome.
VACTERL syndrome.
References.
7. Points to
remember
Technical points.
Key points in the heart exam.
Morphology.
Further Reading.
| Bibliographic details |
Paperback, 174 pages, publication date: JUN-2007
ISBN-13: 978-0-443-10332-2
ISBN-10: 0-443-10332-1
Imprint: CHURCHILL LIVINGSTONE
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062/611
Last update: 25 Nov 2009
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