Evaluation of the fetal heart

Rima Bader MD ,PhD

Professor of Pediatrics, Pediatric &Perinatal cardiology
King Abdul Aziz University College of medicine
Jeddah, Saudi Arabia

Theoretical Advantage of Prenatal Diagnosis

Society
Reduce unnecessary medical costs (transport)
Reduce hospital stay (improved preop status)
Improved outcomes

Medical Professionals

Improved understanding of natural history in utero

Improved counseling
Makes our job interesting
More stable patient
Potential for fetal therapy

Fetal Echocardiography

Indications
Maternal
Fetal
Familial

Fetal Echocardiography

Reason for Referral

Among Affected Pregnancies
Maternal
disease (2%)
Extracardiac
defect (20%)

Family hx (2%)
Other (1%)

Suspected
cardiac defect
on OB U/S (75%)

Fetal Cardiovascular Assessment

Fetal Cardiac Screen
Detailed Fetal Echocardiogram

Fetal Cardiovascular Assessment

Fetal Echocardiography
Detailed assessment of cardiovascular
anatomy by 2-D imaging
Assessment of blood flow within the heart,
systemic and pulmonary veins, and great
arteries
Assessment of ventricular (systolic &
diastolic) function
Assessment of rhythm

Fetal Echocardiography: The Normal Anatomy

Components
Define fetal position including left & right
Defining Visceral-Atrial Situs
The 4 Chamber View
The Outlets, Great Arteries, Arches
3 Vessel View
Basic Rhythm and Function

Abdomen and Four-Chambers

Checklist of upper abdomen

Fetal position

Stomach on left side

Liver on right side
Ao left to the spine
IVC right to the spine ventral
and right to the aorta

Ascites/NIHF (20% cardiac)

IVC
St.

Ao

Situs Inversus Totalis

Situs Solitus

Right Isomerism

Situs Inversus

Left Isomerism

Checklist in Four-Chamber-View I
Size of the heart

Size of the heart

Checklist in Four-Chamber-View I
Size of the heart

Position of the heart

Position of the heart /Shifting

Diaphragmatic hernia

Diaphragmatic hernia

Position of the heart /Heart axis

Dextroversion

Checklist in Four-Chamber-View I
Size of the heart

Position of the heart

Heart axis 45 +- 15

Heart axis

Checklist in Four-Chamber-View I
Size of the heart

Position of the heart

Heart axis 45 +- 15
Rhythm and Contractility
Shifting
Pericardial effusion,
hydrothorax

Hydrops!

Four-Chamber-View
IVS
TV

RV

LV
RA
MV

LA
IAS

Ao

NORMAL 4 chamber view

Foramen ovale!

Four-chamber view: The ventricles

Sternum
RV

LV

RA
LA

RV

LA

LV

RA
R

Atrioventricular discordance
in corrected TGA

Left ventricle

No ventricle

Hypoplasia

Left ventricle

RV
LV

normal size

Dilated

Left ventricle

RV

LV

Dilated

LV

LV

RV
LV
RV

Hypoplastic LV

Hypoplastic RV

Comparison LV/RV width

Aortic coarctation

Single ventricle!

NORMAL 4 chamber view

Insertion of AV-valves

RV
LV
RA
LA

Ebstein

Insertion of AV-valves

AVSD

AV-Valves: Position and Patency

AVSD

3 D-AVSD

RV
LV

RA
LA

Ao

Ao

Five-Chamber-View
Connection of the aorta with the LV

3 vessel view

SVC
Aorta
PA

spine

Five-Chamber-View

Size of the ascending aorta

Override or not override ?

LV

RV

Ao

Normal

Overriding

Pulmonary atresia + VSD

Abnormal 4 chamber view:23

wks! !

Fetal Echocardiography

Spectral Doppler Assessment

IVC/SVC
Pulmonary veins
Foramen Ovale
Mitral and Tricuspid
valve flows

Ventricular
outflows/great arteries
Ductus venosus
Ductus arteriosus
Umbilical artery
Umbilical vein

Fetal Echo:Functional Assessment

Ventricular Diastolic Function

LV isovolumetric
relaxation time
M
V
<50ms
Ao

L EFE Cardiomyopathy

Cardiovascular Profile Score (CVP)

NORMAL
Cardiomegaly
(Heart Area /ChestArea)

-1 POINT

< 0.35

0.35 - 0.50

-2 POINTS
> 0.50

(2 pts)

Peripheral Doppler
(Umbilical artery)

Cardiac Function

Venous Doppler
(Umbilical vein)
(Ductus venosus)

UA
(Normal) (2 pts)

UA
(AEDV)

Normal TV & MV
RV/LV S.F. > 0.28
Biphasic diastolic filling
(2 pts)

Holosystolic TR or
RV/LV S.F. < 0.28

UV

UV

UA
(REDV)

Holosystolic MR or
TR dP/dt < 600 or
Monophasic filling

UV pulsations
DV
(2 pts)
Hydrops

None
(2 pts)

DV
Ascites or
Pleural effusion or
Pericardial effusion

Skin edema

4 chamber view
Function, Rhythm and Anatomy

Blocked PAC

37-channel system

Fetal SVT

Fetal intervention! AS

Thank you!