Radiology
Normal Fetal Heart
Built from Obstetric Imaging
What’s inside
13 sections · 86 slides
Overview
- What this topic covers
Why the fetal heart is scanned at all
How common these defects are, who they happen to, and what finding them early buys
- The commonest severe birth defect
- 0.8%-1%
- The outlook has improved, but not for everyone
- A heart defect rarely travels alone
- Most affected babies come from ordinary pregnancies
- Where the defects actually turn up
- What finding it early buys you
How the normal heart is put together
Three connections on each side - and every one of them has to be checked
- Three connections on each side
- The two chains, side by side
- What a complete examination has to cover
- Two levels of study: screening and advanced
- Who is referred for an advanced study
- Indications for Advance Fetal Echocardiography
- Indications for Advance Fetal Echocardiography (continued)
The five views that screen the heart
One sweep from the belly to the upper chest, with five stops along the way
- One sweep, five stops
- The sweep, stop by stop
- The five screening views of the fetal heart
First stop: the upper abdomen
Before you look at the heart, work out which side of the fetus is which
- The upper abdomen view
- Why start below the heart
- What normal looks like here
- Stomach, aorta, liver and vena cava in place
- Sliding up from the abdomen
The four-chamber view
The single most useful plane in the whole examination
- The four-chamber view
- Why this plane matters most
- Magnified correctly
- The four-chamber checklist
- Where the heart should sit
- Heart position and cardiac axis
- How big the heart should be
- Rhythm, movement and fluid
- Four chambers - and are they even?
- Symmetric chambers and the moderator band
- Telling the right ventricle from the left
- Landmarks that anchor the picture
- The pulmonary veins must reach the left atrium
- Pulmonary venous drainage on colour Doppler
- Where the two valves attach
- Valve offset and the atrioventricular septum
- Do the valves actually work?
- The wall between the ventricles
- An intact wall between the ventricles
- The wall between the atria
Five-chamber view: the aorta leaving
One small tilt towards the head, and the exit road of the left ventricle appears
- The left outflow tract view
- One small tilt from four chambers
- What to confirm in this view
- The aorta rising from the left ventricle
Short-axis view: the pulmonary artery leaving
The plane that catches the defects a normal four-chamber view hides
- The right outflow tract view
- Keep tilting towards the head
- The crossing is the key sign
- The great arteries crossing over each other
- Checklist for the right outflow view
- Telling the pulmonary artery from the aorta
- What else appears in this plane
Three vessels and trachea
Both arterial arches and the windpipe, all in one easy cross-section
- The three-vessel and trachea view
- The easiest way to see both arches
- What sits where, left to right
- Reading the picture
- Both arches, vena cava, trachea and thymus
- What this view is for
- Normal forward flow in both arches
The long views: arches and great veins
Sagittal planes that belong to the advanced study, and what to do if you cannot get them
- What the long views add
- The ductal arch is a hockey stick
- The aortic arch is a candy cane
- The aortic arch and its head and neck branches
- The great veins reaching the right atrium
- If you cannot get the long views
Looking earlier: 11 to 14 weeks
Two first-trimester markers, and what an early diagnosis is worth
- Two early markers point at the heart
- Early echocardiography works - in trained hands
- Why earlier helps the family
What the views are hunting for
The defects ultrasound can find before birth, in order of frequency - and the ones it cannot
- The defects, in order of frequency
- Ventricular septal defect
- Hypoplastic left heart syndrome
- Fallot and transposition: the outflow pair
- Why those two are worth finding
- Atrioventricular septal defect
- Coarctation of the aorta
- The rest - and the ones you will not see
- Can ultrasound see it before birth?
Getting a good picture
The machine settings that decide whether any of the above is visible at all
- Machine settings that matter
- Colour Doppler settings
- Key points
- Suggested reading
- References
- References (continued)
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition