胎儿的循环系统(英文版).ppt

Fetal Cardiology Kottler NE, Leopold GR, O’Boyle 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 Heart fills one third of the chest The Four Chamber View Apex points to the left (45 degree angle) The Four Chamber View Size of right chambers approximates left chambers The Four Chamber View MV and TV move on real time imaging Ventricular septum symmetric The Four Chamber View 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 Pitfalls: PseudoVSD When the IV septum pa