胎儿心脏的正常和异常超声解剖
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• Position - apex left; heart left • Axis- 45o ± 20o • Size - < 50% in diameter; 1/3 in area • Ventricles - size, echogenicity • Atria - size • AV valve off-setting • Ventricular septum - intact • Pulmonary veins – to left atrium • Rhythm- regular • Pericardial effusion?
胎儿心脏的正常和异常超声解剖
刘子建 香港中文大学妇产科学系
Prenatal diagnosis of CHD 先天性心脏病的产前诊断
• Retrospective review • 131,60 routine scan of low risk
pregnancies • Sensitivity: 9.25 only.
4-chamber view:
4-cThhaembkeery tvoiecwardailaocneevacluaantidoentect 四腔心7：0%评估of心C脏DH的s关键
Cross-sectional plane
USG plane
Normal anatomy 正常解剖
• Left atrium NOT on the left, but at the back, near the mid-line
Foramen ovale
R
Pulmonary vein
A
MV
LA
RA LV RV
TV
Anatomy of the fetal heart- 4 chambers 胎儿心脏解剖—四腔心
Anterior
RV
RA LV LA
S A
Post
Sub-costal view
4-chamber view 四腔心观
• 50% detected by less experienced ones
Tegnander & Eik-Nes UOG 2006
Common CHD 常见的先天性心脏病
• Dextroposition and dextrocardia 右移位和右位心 • ASD 房缺 • VSD 室缺 • Hypoplastic left heart syndrome 左心发育不良综合症 • Univentricular heart 单心室 • Ebstein’s anomaly 三尖瓣下移畸形 • Cardiac tumour 心脏肿瘤 • Fetal arrhythmias 胎儿心律失常 • Fetal cardiomyopathies 胎儿心肌病
35/82 major CHDs detected on routine scan
Leabharlann Baidu
43%
58 CHDs expected to have Abn 4-chamber views
71%
41/58 detected by Abn 4-chamber views
71%
Tegnander & Eik-Nes UOG 2006
Vergani P et al. AJOG 1992
• 5400 low risk pregnancies: 48%
Achiron R et al BMJ 1992
• 15,281 low risk pregnancies: 16%
Crane JP et al. AJOG 1994
29,035 fetuses 1991-2001
Check list 检查内容
• Position, size and axis of heart 心脏位置、大小及心轴 • Presence and size of 4 chambers 四腔心的位置和大小 • Rhythm 心律 • Atrio-ventricular septum 房室间隔 • AV valve position 房室瓣的位置 • Endocardium, myocardium, pericardium 心内膜、心肌、心包
Experience and pick-up rate 经验和发现率
Experienced: > 2,000 scans Less Experienced: >200 scans
• 58 CDHs with expected abn 4chamber views
• 87.5% detected by experienced ones
Position and axis 位置和心轴
• Levocardia: normal orientation
• Dextrocardia: heart in R side of chest, apex pointing to the R
• Right atrium on the right and in the front of the left atrium
• Right ventricle and outflow (PA) in the front
• Left ventricle posterior and to the left of the right ventricle
Common CHD 常见的先天性心脏病
• Aortic and pulmonary stenosis 主动脉和肺动脉狭窄 • Coarctation of aorta 主动脉缩窄 • Tetralogy of Fallot 法洛氏四联症 • Truncus arteriosus • Transposition of great vessels 大动脉转位 • DORV & DOLV 右室双出口 左室双出口
Stoll C et al Prenat Diagn 1993
4 Chamber View 四腔心
4 chamber view: Sensitivity 四腔心：敏感性
• 1022 high risk pregnancies: 92%
Copel JA et al. AJOG 1987
• 3680 low risk pregnancies: 81%
胎儿心脏的正常和异常超声解剖
刘子建 香港中文大学妇产科学系
Prenatal diagnosis of CHD 先天性心脏病的产前诊断
• Retrospective review • 131,60 routine scan of low risk
pregnancies • Sensitivity: 9.25 only.
4-chamber view:
4-cThhaembkeery tvoiecwardailaocneevacluaantidoentect 四腔心7：0%评估of心C脏DH的s关键
Cross-sectional plane
USG plane
Normal anatomy 正常解剖
• Left atrium NOT on the left, but at the back, near the mid-line
Foramen ovale
R
Pulmonary vein
A
MV
LA
RA LV RV
TV
Anatomy of the fetal heart- 4 chambers 胎儿心脏解剖—四腔心
Anterior
RV
RA LV LA
S A
Post
Sub-costal view
4-chamber view 四腔心观
• 50% detected by less experienced ones
Tegnander & Eik-Nes UOG 2006
Common CHD 常见的先天性心脏病
• Dextroposition and dextrocardia 右移位和右位心 • ASD 房缺 • VSD 室缺 • Hypoplastic left heart syndrome 左心发育不良综合症 • Univentricular heart 单心室 • Ebstein’s anomaly 三尖瓣下移畸形 • Cardiac tumour 心脏肿瘤 • Fetal arrhythmias 胎儿心律失常 • Fetal cardiomyopathies 胎儿心肌病
35/82 major CHDs detected on routine scan
Leabharlann Baidu
43%
58 CHDs expected to have Abn 4-chamber views
71%
41/58 detected by Abn 4-chamber views
71%
Tegnander & Eik-Nes UOG 2006
Vergani P et al. AJOG 1992
• 5400 low risk pregnancies: 48%
Achiron R et al BMJ 1992
• 15,281 low risk pregnancies: 16%
Crane JP et al. AJOG 1994
29,035 fetuses 1991-2001
Check list 检查内容
• Position, size and axis of heart 心脏位置、大小及心轴 • Presence and size of 4 chambers 四腔心的位置和大小 • Rhythm 心律 • Atrio-ventricular septum 房室间隔 • AV valve position 房室瓣的位置 • Endocardium, myocardium, pericardium 心内膜、心肌、心包
Experience and pick-up rate 经验和发现率
Experienced: > 2,000 scans Less Experienced: >200 scans
• 58 CDHs with expected abn 4chamber views
• 87.5% detected by experienced ones
Position and axis 位置和心轴
• Levocardia: normal orientation
• Dextrocardia: heart in R side of chest, apex pointing to the R
• Right atrium on the right and in the front of the left atrium
• Right ventricle and outflow (PA) in the front
• Left ventricle posterior and to the left of the right ventricle
Common CHD 常见的先天性心脏病
• Aortic and pulmonary stenosis 主动脉和肺动脉狭窄 • Coarctation of aorta 主动脉缩窄 • Tetralogy of Fallot 法洛氏四联症 • Truncus arteriosus • Transposition of great vessels 大动脉转位 • DORV & DOLV 右室双出口 左室双出口
Stoll C et al Prenat Diagn 1993
4 Chamber View 四腔心
4 chamber view: Sensitivity 四腔心：敏感性
• 1022 high risk pregnancies: 92%
Copel JA et al. AJOG 1987
• 3680 low risk pregnancies: 81%