胎儿的循环系统英文版.ppt

Fetal CardiologyKottler NE, Leopold GR, O’Boyle M, Pretorius D, Sirlin CB Fetal CardiologyCardiac anomalies are the most frequently overlooked group of abnormalitiesCongenital heart disease = 0.8% of all pregnancies4% one sibling affected; 10% two siblings affected9% father affected12% mother affectedCauses 50% deaths from congenital disease Fetal CardiologyRisk 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 CardiologyAIUM / 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 standards4 chamber view alone: 33-63% sensitiveWith outflow tracts: 83-85% sensitive [2] GOALSReview normal cardiac anatomy and its sonographic appearance (four chamber, LVOT, RVOT)Explore diagnostic pitfallsReview the appearance of more common structural cardiac defects The Four Chamber ViewHeart fills one third of the chest The Four Chamber ViewApex points to the left (45 degree angle) The Four Chamber ViewSize of right chambers approximates left chambers The Four Chamber ViewMV and TV move on real time imagingVentricular septum symmetric The Four Chamber ViewPortion of the atrial septum present (crus) Left Ventricular Outflow TractIdentify: LV, RV, IV septum, aorta (normal caliber), +/- LA, +/- RAMedial 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 TractIdentify: 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 aortaPathology: transposition, truncus arteriosus SpineSpLeft AtriumRight AtriumLeft VentricleRight VentricleModerator BandForamen