Fetal heart ultrasound : how, why, and when. 3 steps and 10 key points

Front cover
Fetal Heart Ultrasound
Copyright page
Table of Contents
Website contents
Foreword to the first edition
Foreword to the first edition
Acknowledgments
Abbreviations
1 Why: fetal heart ultrasound
	Chapter contents
	General notions
		Criteria for normality
	Review
		Development
		Anatomic ultrasound correlations
		The crux of the heart
			Outflow
			The great vessels
			The arches
		Several fetal hemodynamic elements
			Examples of inlet pathologies
			Examples of outlet pathologies
	Application to fetal cardiopathies
		The concept of the architectural spectrum
		Etiologic orientation
	References
2 How: technical aspects
	Chapter contents
	The physical principles of ultrasound as applied to  fetal ultrasound
		Tissue elasticity
			Example of tissue elasticity
		Reflection of ultrasound
		The principle of the shortest path
		Going around obstacles
	What takes time?
		The surface to be explored
		The number of crystals stimulated
		Distance traveled from the point of view of time
		The number of focal zones
		The use of color Doppler
	The physical principles of doppler
		Doppler color and time
			Continuous Doppler
			Pulsed Doppler
			Color Doppler
			Power Doppler
		Incident angle
			Example
		Pulse repetition frequency and aliasing
		The 3D technique
		In practice: the settings
	In practice: setting the controls
		The 2D settings
			Zoom
				Example of using the zoom
			Focus
			Gain
			Preset elements
				Dynamic range
			Frequency
			The density of pulse lines per image
			Persistence
			Contours
		Doppler settings
			The direction of the incident wave
			Pulse repetition frequency
			Color gain
	Application to the examination of the fetal heart
		The echo-structure
		The position of the fetal heart
			The movements
	Further reading
3 How: anatomic–ultrasound correlations: 3 steps, 10 key points
	Chapter contents
	First step. verification of the position: 2 key points
		In practice
		Verification of lateralization
			Position of the organs
			Vessel position
				Axis of the heart
	Second step. verification of the inlet: 4 key points
		In practice
			Point 3: the heart is attached by the inferior PV
			Points 4 and 5: the four chambers  should be balanced and concordant
			Point 6: the two permeable  and offset atrioventricular valves
	Third step. verification of the outlet: 4 key points
		In practice
			Point 7: the verification of  septal– and mitral–aortic continuity
			Point 8: crossing of the two vessels
			Point 9: balance and concordance of the vessels
			Point 10: regular aortic arch
	References
4 How: conducting the examination and its pitfalls
	Chapter contents
	Taking the history
	A fast glance
		Different views that verify the 10 key points, their pathways, and their pitfalls
	Verification of lateralization and its pitfalls: the elevator
		The technique
		Pitfalls
			The position of the fetus: lateralization elements
			Organ position
			Abdominal vessel position
		Four-chamber view: verification of the outlet and its pitfalls
			The technique
		The axial–apical pathway
			Why
			How
		The axial–transverse pathway
			Why
		View of the crux of the heart
			Why
			How
		Pitfalls of the inlet or four-chamber view
			The axis of the heart and the aorta to the left
			The axis of the heart
			Swings in the four-chamber view
			Lateral swings: asymmetries
			For an inferior–superior swing:  false AVSD and VSD
			Four-chamber view and concordance
		Aspect of a false echogenic tumor of the  right ventricle
		Four-chamber view and foramen ovale valve
		Verification of the outlet and its pitfall
			The LV–Ao view
			The technique
		The axial–apical LV–Ao view
			Why
		The preferred axial–lateral view
			Why
		The LV–Ao “SOS” view: sagittal oblique
			Why
			How
		Pitfalls of the LV–Ao view
		The RV–PT view
		Axial transverse view
			Why
			How
		View of the right tract, small axis
			Why
			How
		Pitfalls of the RV–PT view
		The three-vessel view or the two crosses
			Why
			How
		Pitfalls of a normal three-vessel view
		Sagittal view of the aortic arch
			Why
			How
		Pitfalls of the aortic arch view
	References
	Further reading
5 First-trimester cardiac scan and study
	Chapter contents
	Introduction
		Why?
		Who?
		What?
		When?
		How?
	Technical aspects: equipment
		Tissue harmonic imaging (THI)
		Compound imaging
		Post-processing
	Technical aspects: settings
		Color flow modalities
			Color Doppler
			Power Doppler
			B/E-flow ultrasound
		Technical aspects: summary
	Examination: risk factors
		Nuchal translucency (NT)
		Tricuspid valve regurgitation
		Ductus venosus
		Risk factors: in summary
	Anatomic correlation and  its limitations
		Step 1: verification of the position of the heart
		Step 2: verification of the inlet
		Step 3: verification of the outlet tract
		Fetal cardiologists
		Pathologists
		Histological imaging
			Magnetic resonance imaging
			Computed tomography
	References
	Further reading
6 Why: critical cardiac pathologies not to be overlooked
	Chapter contents
	First step. pathologies of position
		Anomalies of visceral positioning
		Vessel position anomalies
			Not one but two vessels in front and  to the left of the spine on the TAD image
			Anomalies of organ or vessel  position at the abdominal level, which  are present in VAH, are elements of orientation
			The descending aorta is found— not in front and to the left—but on  the right of the spine in the four-chamber view
		Anomalies concerning the position  of the heart
		Anomalies that modify the axis of the heart
			The angle can be clearly superior to  45 with a distinct asymmetry of the chambers
			The inlet chambers remain symmetric
			The angle can be inferior to 45°
			The axis can be negative with  the apex of the heart to the right
	Second step. pathologies  of the inlet
		Point 3: heart on the diaphragm
		Point 4: if we cannot distinguish  the four chambers
			Three chambers
			Four+ chambers
			Five chambers
		Point 5: asymmetric or discordant chambers
			If the chambers are asymmetric we can  distinguish a variety of architectural malformations
			In cases where the chambers are discordant
		Point 6: rings that are impermeable  or not offset
	Third step. pathologies  of the outlet
		Point 7: pathology
		Point 8: the verification of the crossing over of the great vessels is a critical moment
		Point 9: a lack of balance can involve several elements
			A lack of balance between the chambers
			Vessel imbalance
		Point 10: irregular aortic arch
			Attention
	References
7 When: fetal morphological examination after the discovery of a cardiopathy
	Chapter contents
	Two possibilities exist
		The karyotype is unknown
			Warning signs of chromosomal anomalies
				Trisomy 21 (T21; Down syndrome)
				Trisomy 18 (T18; Edwards syndrome)
				Trisomy 13 (T13; Patau syndrome)
				Turner syndrome
				Triploidy
		The karyotype is known  to be normal
			Fetal alcohol syndrome
			Smith–Lemli–Opitz syndrome (SLOS)
			The CHARGE association
			Cornelia de Lange syndrome
			Cardiopathies associated with  skeletal anomalies
				Long bones
			Cardiopathies associated with  cephalic anomalies
			Cardiopathy associated with visceral anomalies
	References
8 Points to remember
	Chapter contents
	Technical points to remember
	Key points to remember
	Pathologies to remember
		The position anomalies
		The inlet anomalies
		Outlet anomalies
	Morphological points  to remember
	Conclusion
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	K
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	M
	N
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	T
	U
	V
	W
	Z