1. Fetal Heart Ultrasound: WHY
Application to Fetal Cardiopathies.
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.
Elements to Set Permanently.
The dynamic range.
The size of the ?box.?
The incident wave direction.
The use of Ultrasound in examining the fetal heart.
The fetal heart position.
Movements of the target.
Problems linked to exposure in the zone of interest.
3. HOW: Anatomic ? ultrasound correlations: 3 steps, 10 key points
1st step: Position: 2 key points.
The axis of the heart.
2nd Step, Inflow: 4 key points.
Heart, Diaphragm and pulmonary veins.
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.
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.
Its pitfalls: elements of lateralization.
The four chamber view: inlet verification and its pitfalls.
Axial apical pathway.
The Ao and apex of the heart on the same side to the Left.
The heart's axis.
Lateral fluctuation: asymmetries.
Anterior-posterior movements: false AVSD and false VSD.
Axial lateral view.
"SOS" view: Sagittal and its pitfalls.
Small axis view and its pitfalls.
The 3 vessel or 2 arches view.
Sagittal view and the aortic arch.
5. WHY: Critical cardiac pathologies not to be overlooked
1st Step: Position pathologies: 2 key points.
Position anomalies of the organs, of situs.
Anomalies of the Position of the Heart.
In the right thorax.
2nd Step: Inlet Pathologies: 4 key points.
Anomalies of pulmonary venous return.
Irregular number of chambers: 3, 4+ or 5 chambers.
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.
6. WHEN: Fetal morphological examination after the discovery of a cardiopathy
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.
7. Points to remember
Key points in the heart exam.