胎儿的循环系统(英文版).ppt

Fetal Cardiology Kottler NE,Leopold GR,OBoyle M,Pretorius D,Sirlin CB Fetal Cardiology Cardiac anomalies are the most frequently overlooked group of abnormalities Congenital heart disease=0.8%of all pregnancies 4%one sibling affected;10%two siblings affected 9%father affected 12%mother affected Causes 50%deaths from congenital disease Fetal Cardiology Risk Factors for congenital heart disease:Family history Recurrence risk(hypoplastic left heart as high as 13.5%)Nongestational DM Maternal infection(rubella)Lupus Drugs(anticonvulsants,etoh,amphetamines,ocp,vit A,steroids,etc.)Fetal Cardiology AIUM/ACR standards in the 2nd and 3rd trimesters include:Four chamber view Position of fetal heart in the thorax LVOT and RVOT not yet part of standards 4 chamber view alone:33-63%sensitive With outflow tracts:83-85%sensitive 2 GOALS Review normal cardiac anatomy and its sonographic appearance(four chamber,LVOT,RVOT)Explore diagnostic pitfalls Review the appearance of more common structural cardiac defects The Four Chamber View 1.Heart fills one third of the chest The Four Chamber View 2.Apex points to the left(45 degree angle)The Four Chamber View 3.Size of right chambers approximates left chambers The Four Chamber View 1.MV and TV move on real time imaging 4.Ventricular septum symmetric The Four Chamber View 6.Portion of the atrial septum present(crus)Left Ventricular Outflow Tract Identify:LV,RV,IV septum,aorta(normal caliber),+/-LA,+/-RA Medial wall of the ascending aorta merges with the top of the IV septum(most frequent location for VSD)Pathology:VSD,tetralogy of Fallot,transposition,truncus arteriosus Right Ventricular Outflow Tract Identify:branching of the main PA into right PA and ductus arteriosus(to desc Aorta),asc aorta in cross section,desc aorta to left of spine;verify PA crosses anterior to asc aorta Pathology:transposition,truncus arteriosus Spine Sp Left Atrium Right Atrium Left Ventricle Right Ventricle Moderator Band Foramen Ovale Four Chamber Interventricular Septum Left Atrium Left Ventricle Right Ventricle Aorta Mitral Valve(closed)Aortic Valve(open)Interventricular Septum Left Ventricular Outflow Tract Right Ventricular Outflow Tract Right Atrium Right Ventricle Main Pulmonary Artery Right Pulmonary Artery Ductus Arteriosus Ascending Aorta Ao Tricuspid Valve Pulmonic Valve(open)Descending Aorta dAo Sp Pitfalls:PseudoVSD When the IV septum parallels the US beam,resultant echo drop out looks like VSD IV septum normally tapers near the AV valves Corrected by changing the angle of view IV septum parallels US beam (echo dropout)Changing Angle Pericardial effusion?NO!Normal amount fluid(PA Tetralogy of Fallot video Courtesy of Dr Alfred Albahamed click image to play video Endocardial Cushion Defect 5%of CHD Recur risk=3%(1 sib),10%(2 sibs),1%(dad),14%(mom)Freq assoc with other anomalies;strong assoc with Trisomy 21 Large defect at the crus of heart on four chamber view Endocardial Cushion Defect Several types depend on how AV valves attach.Most common is type III,complete AV canal and common AV valve Endocardial cushions fail to fuse;cause defect in both the atrial and ventricular septae(AV canal)Endocardial Cushion Defect atria vents Endocardial Cushion Defect 4 Chamber View Endocardial Cushion Defect 4 Chamber View Courtesy of Dr Mark Skalansky Endocardial Cushion Defect atria vents Endocardial Cushion Defect vents atria Endocardial Cushion Defect video click image to play video Transposition of Great Vessels D-type(“complete”)=heart tube loops to the right normal orientation of ventricles;but vessels malform(cyanosis)L-type(“congenitally corrected”)=heart tube loops to the left ventricular inversion,but normal vessel orientation(no cyanosis)Childrens Virtual Hospital Transposition of the Great Vessels 4-6%of CHD Recurrence risk=1.5%(1 sib),5%(2 sibs)Association with excessive vitamin A Rarely associated with chromosome abnormalities 4 Transposition Great Vessels VSD(30-50%)Aorta arises anterior and to the right of PA;great vessels parallel each other 5 year survival(surgery)90%Transposition Great Vessels Courtesy of Dr Mark Skalansky Transposition Great Vessels video Courtesy of Dr Alred Albafamed click image to play video(video starts slowly)Hypoplastic Left Heart 2-4%of CHD 3 Hypoplasia of the LV;MV/AV stenosis or atresia Assoc with coarctation of aorta(80%)when AV atretic Hypothesis:low blood flow to LV causes hypoplasia Hypoplastic Left Heart Causes hypoperfusion of coronary arts;CHF from ischemia Cyanosis at birth if LA to RA shunt not adequate Associated with chromosomal anomalies=16%(one half from Trisomy 18 alone)4 Hypoplastic Left Heart 4 Chamber View Hypoplastic Right Heart Underdevelopment of right sided heart structures Hypoplasia of the RV and PA;RV wall thick;hypoplastic or incompetent TV;PV atresia Relies on patent ductus arteriosus for blood supply to lungs(PGE1)Tx=surgical sytemic to pulmonary shunt(Blalock Taussig Shunt)Hypoplastic Right Heart Small RV,thick wall Hypoplastic Right