Abnormal Fetal Heart Part 2 PDF

ULTR‐3014 OBGYN Sonography 3 Module O.12: Abnormal Fetal Heart & Abdomen 2 Abnormal Fetal Heart – Part 2 49 50 Intracardiac Masses Rhabdomyoma Benign tumour of striated muscle Intracardiac Masses • Most common cardiac mass (though can be extracardiac) • Hyperechoic • Usually multiple • Of...

ULTR‐3014 OBGYN Sonography 3 Module O.12: Abnormal Fetal Heart & Abdomen 2 Abnormal Fetal Heart – Part 2 49 50 Intracardiac Masses Rhabdomyoma Benign tumour of striated muscle Intracardiac Masses • Most common cardiac mass (though can be extracardiac) • Hyperechoic • Usually multiple • Often associated with tuberous sclerosis • Angiofibroma, epilepsy, intellectual disability youtu.be/VbAs2PfF8Gg 1:52 51 Rare 52 Rhabdomyoma – signs and symptoms • Rhabdomyomas Caused by obstruction to the outflow tract • Congestive heart failure • Pericardial effusion • Hydrops • Fetal demise • Hyperechoic, homogeneous masses (*) Ultrasonography in Obstetrics and Gynecology, 5th Edition (Callen fig 14‐51) 53 54 Rhabdomyomas • Large, hyperechoic mass filling LV Rhabdomyomas Textbook of Diagnostic Sonography, 7th Edition (Hagen‐Ansert fig 34‐44) 9 ULTR‐3014 OBGYN Sonography 3 Module O.12: Abnormal Fetal Heart & Abdomen 2 Abnormal Fetal Heart – Part 2 55 56 Outflow Tract Views Cardiac anomalies seen Cardiac Anomalies Outflow Tract Views 57 • Overriding aorta • Tetralogy of Fallot • Truncus arteriosus • Complete transposition of great vessels • Double outlet right ventricle 58 Overriding Aorta Definition Aorta positioned over a VSD instead of over the LV Overriding Aorta 59 • Aorta is displaced to the right • Associated with Tetralogy of Fallot • See next slide 60 Tetralogy of Fallot Four abnormalities Tetralogy of Fallot 1. Overriding Ao 2. VSD 3. RVOT/Pulmonary stenosis (small PA) 4. RV hypertrophy PAS view!!! youtu.be/BQea4S6oTfM 2:38 10 ULTR‐3014 OBGYN Sonography 3 Module O.12: Abnormal Fetal Heart & Abdomen 2 Abnormal Fetal Heart – Part 2 61 NORMAL 62 TETRALOGY OF FALLOT neonatal 63 64 4CH view of the LVOT 4CH – VSD • VSD • 22 weeks GA • Overriding aorta • Ventricular septal defect seen • Confirmed tetralogy of Fallot Textbook of Diagnostic Sonography, 7th Edition (Hagen‐Ansert fig 53‐11) 65 66 PAS view – pulmonary stenosis • PA appears smaller than the AO Truncus Arteriosus NORMAL P A S 11 ULTR‐3014 OBGYN Sonography 3 Module O.12: Abnormal Fetal Heart & Abdomen 2 Abnormal Fetal Heart – Part 2 67 68 Truncus Arteriosus NORMAL TRUNCUS ARTERIOSUS Definition Single arterial trunk arises from the heart • • • Outflowing vessels arise from the truncus • Aorta • Pulmonary trunk or R & L pulmonary arteries Ventricular septal defect usually present May be difficult to differentiate from a severe tetralogy of Fallot 69 T neonatal 70 Textbook of Diagnostic Sonography, 7th Edition (Hagen‐Ansert fig 34‐41, 42) LAX RVOT LAX LVOT Truncus arteriosus – outflow tract view RV RA PA LV T TR‐V Truncus arteriosus – outflow tract view 71 Long axis (LAX) Short axis (SAX) Pulmonary trunk arises from aorta (arrowhead) 72 PAS view – power Doppler • Only two “PAS” vessels seen • 1: truncus • 2: SVC • (Ao: descending aorta) • Truncus gives rise to right and left PAs Ultrasonography in Obstetrics and Gynecology, 5th Edition (Callen fig 14‐39) Complete Transposition of Great Vessels youtu.be/8WQwFiuBKB8 3:45 12 ULTR‐3014 OBGYN Sonography 3 Module O.12: Abnormal Fetal Heart & Abdomen 2 Abnormal Fetal Heart – Part 2 73 Complete Transposition of Great Vessels Normal LAX views LVOT Definition Ao arises from RV and PA arises from LV • Normal atrioventricular connections • Great vessels are parallel • Do not cross RVOT 74 Complete transposition of great vessels Textbook of Diagnostic Sonography, 7th Edition (Hagen‐Ansert fig 34‐39) 75 76 COMPLETE TRANSPOSITION OF GREAT VESSELS Rendered power Doppler volume images • 3D reconstruction Ultrasonography in Obstetrics and Gynecology, 5th Edition (Callen fig 24‐40) 77 78 Double Outlet Right Ventricle Definition PA and most of Ao arise from RV Double Outlet Right Ventricle • Great vessels may run parallel to each other • Ventricular septal defect • Similar to an overriding aorta (but without stenosis to the pulmonary artery) • Double outlet right ventricle is NOT tetralogy of Fallot 13 ULTR‐3014 OBGYN Sonography 3 Module O.12: Abnormal Fetal Heart & Abdomen 2 Abnormal Fetal Heart – Part 2 79 80 NORMAL DOUBLE OUTLET RIGHT VENTRICLE Double outlet right ventricle outflow tracts cross in this example 81 outflow tracts parallel in this example 82 Double outlet right ventricle • RVOT view • Both Ao and PA arise from RV • Ventricular septal defect not seen in this image Fetal Congestive Heart Failure Ultrasonography in Obstetrics and Gynecology, 5th Edition (Callen fig 14‐37) 83 84 Fetal Congestive Heart Failure Definition Failure of fetal heart to adequately pump blood throughout fetus Fetal congestive heart failure – causes • Arrhythmia • Anemia • End stage cardiac failure results in hydrops • CHD • Evaluated by fetal echocardiography • Cystic hygroma • Etc. CHD Congenital heart disease 14 ULTR‐3014 OBGYN Sonography 3 Module O.12: Abnormal Fetal Heart & Abdomen 2 Abnormal Fetal Heart – Part 2 85 86 Cardiomegaly • Decreased thoracic circumference to heart circumference ratio • Heart appears to occupy more than 1/3 of the chest • Can also compare area in lieu of circumference (like in this image) Fetal congestive heart failure – sonographic findings • Hydrops • Pericardial effusion plus fluid accumulating somewhere else in the fetus (i.e. ascites, pleural effusion, edema) • Cardiomegaly • Abnormal myocardial function • Doppler findings in umbilical vein and artery 87 Premature Closure or Constriction of Ductus Arteriosus 88 Definition Abnormal closure of ductus arteriosus before birth Premature Closure or Constriction of Ductus Arteriosus • • 89 Fetal Heart – Pitfalls Due to certain drugs • Indomethacin • Management of premature labour • Nonsteroidal anti‐inflammatory medications • e.g. ibuprofen DA evaluation with US performed on high risk fetuses 90 online reference goo.gl/yTo8sO – dead link  (summarized in Learn) • • • FETAL HEART John P. McGahan, MD & Beryl Bencerraf, MD Pitfalls: pages 8‐10 check this out! Module O.12 Abnormal Fetal Heart & Abdomen Abnormal Heart – Part 2 END 15