Fetal Echocardiography Dr. A. K. KAPOOR Specialist Cardiologist MBBS, MD(Med), DM(Card)

What is Congenital Heart Defect? Congenital heart defects occur during the development of the heart in pregnancy Most common congenital anomaly (25%) Affects almost 1 percent of all babies born – and 50 percent of babies with a CHD are seriously affected and will need treatment before 1 year old.

What is Fetal Echocardiography? The use of ultrasound waves to investigate the fetal heart-the structure and action of the heart.

Multi-disciplinary Team

Fetal Circulation

Cardiac Embryology

Who all should undergo? High Risk Approach FETAL Abnormal 4C view Extracardiac anomalies GIT, Spina bifida Chromosomal anomalies Vacterl, Trisomies, Digeorge Non immune hydrops IVF/ICSI Irregular Heart Beat Increased First Trimester NT Abnormal cardiac axis MATERNAL Maternal CHD Maternal auto - immune disease Teratogen exposure Metabolic disorder DM, PKU Intra uterine Infections FAMILIAL Previous child with CHD Paternal CHD Mendelian Syndromes TS, Noonan;s, Digeorge

Timing of Fetal Echocardiography The best time to do a fetal cardiac exam is 18-22 weeks Later exams may show anatomy better but might be difficult because of rib shadowing Adequate exam depends on fetal position and maternal habitus Some pathologies become obvious with fetal age

Fetal Circulation

Ultrasound Hand Movements

Normal Ultrasound Scan

Rate and Rhythm The heart rate is usually 120-160/min, the rhythm is regular but transient bradycardia is normal in the 2nd trimester but not in the 3rd

Views and Windows

Four Chamber View

5 Chamber Apical View

Lower end of septum Foramen ovale Flap of foramen ovale in LA Atria Lower end of septum Foramen ovale Flap of foramen ovale in LA

Foramen Ovale

Moderator band identifies right ventricle Basic Fetal Cardiac Examination - Ventricles Equal size Intact septum Moderator band identifies right ventricle

Basic Fetal Cardiac Examination – AV Values Tricuspid valve inserted more apically than mitral Both valves move freely

Extended basic cardiac examination The outflow tracts are imaged by tilting the probe towards the fetal head The great vessels should be of equal size and should cross at approximately 90° as they emerge from their respective ventricles

Outflow Tracts – RVOT/LVOT

LVOT

Aortic Arch

Ductal Arch

RVOT Short Access View

4-C view with PD mitral flow

LVOT with PD flow

Echogenic Intracardiac Focus (EIF) Can be seen in up to 6% of normal pregnancies Highly operator and machine dependant Associated with cardiac and extracardiac anomalies Bilateral EIF is more significant

- 38Y, Female - Echogenic Focus - Normal Fetal Echo Study - Normal CV System - 31Y, Female - Multiple Echogenic Focus - Had some evidence of down syndrome - EC Defects – Complex - Child Survived

Echogenic Intracardiac Focus (EIF) Biventricular EIF are more significant this patient was 47XY Normal nuchal translucency

Pericardial Effusion

Hypoplastic left heart Single atrium Large VSD

Tricuspid

30 Y, Female - Chinese First Child Now Child is 1 Y Fetal Echo

TOF

TOF Outflow Tract

Echocardiography - Tetralogy of Fallot

Endocardial Cushion Defect

Echocardiography - ECD

EBSTEIN ANAMOLY

Dextrocardia

Echocardiography - Pulmonary Stenosis

Echocardiography - Severe Aortic Stenosis

Echocardiography - Ventricular Septal Defects

WHAT IS ALL ABOUT? Twin Heart

THANK YOU

Four Chamber View

LVOT/RVOT

Echogenic Intracardiac Focus

DIAGNOSTIC ACUMEN