胎儿的循环系统(英文版)

Baidu NhomakorabeaOALS
• Review normal cardiac anatomy and its sonographic appearance (four chamber, LVOT, RVOT)
• Explore diagnostic pitfalls • Review the appearance of more common structural cardiac defects
Ascending Aorta Tricuspid Valve Pulmonic Valve (open)
Right Ventricular Outflow Tract
Descending Aorta
Pitfalls: PseudoVSD
IV septum parallels US beam (echo dropout)
Fetal Cardiology
• AIUM / 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 standards • 4 chamber view alone: 33-63% sensitive • With outflow tracts: 83-85% sensitive [2]
Spine
Left Atrium Right Atrium Left Ventricle Right Ventricle Moderator Band
Sp
Foramen Ovale
Four Chamber
Interventricular Septum
Left Atrium Left Ventricle Right Ventricle Aorta Mitral Valve (closed) Aortic Valve (open)
Right Ventricular Outflow Tract
• Identify: branching of the main PA into right PA and ductus arteriosus (to desc Aorta), asc aorta in cross section, desc aorta to left of spine; verify PA crosses anterior to asc aorta • Pathology: transposition, truncus arteriosus
• Congenital heart disease = 0.8% of all pregnancies
4% one sibling affected; 10% two siblings affected 9% father affected 12% mother affected
• Causes > 50% deaths from congenital disease
Interventricular Septum
Left Ventricular Outflow Tract
Right Atrium Right Ventricle
Main Pulmonary Artery
Ao Right Pulmonary Artery Ductus Arteriosus
dAo Sp
The Four Chamber View
1. MV and TV move on real time imaging 4. Ventricular septum symmetric
The Four Chamber View
6. Portion of the atrial septum present (crus)
Fetal Cardiology
Kottler NE, Leopold GR, O’Boyle M, Pretorius D, Sirlin CB
Fetal Cardiology
• Cardiac anomalies are the most frequently overlooked group of abnormalities
Fetal Cardiology
• Risk 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.)
Left Ventricular Outflow Tract
• Identify: LV, RV, IV septum, aorta (normal caliber), +/LA, +/- RA • Medial wall of the ascending aorta merges with the top of the IV septum (most frequent location for VSD) • Pathology: VSD, tetralogy of Fallot, transposition, truncus arteriosus
The Four Chamber View
1. Heart fills one third of the chest
The Four Chamber View
2. Apex points to the left (45 degree angle)
The Four Chamber View
3. Size of right chambers approximates left chambers