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Pitfalls in Fetal Echocardiography

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Presentation on theme: "Pitfalls in Fetal Echocardiography"— Presentation transcript:

1 Pitfalls in Fetal Echocardiography
Jung Yun Choi Department of Pediatrics Seoul National Univ. Children’s Hospital

2 Pitfalls of Fetal Echocardiography
Pitfalls due to technical factors Pitfalls related to interpretation

3 Pitfalls due to technical factors
Structural Image Doppler Spectral Image Color Doppler image

4 Pitfalls in Structural Image
Echo drop-out Artifact : Shadowing Imperfect resolution Slice thickness

5 Echo drop-out; Shodowing; Artifact

6 Pitfalls in Color Doppler image
Low frame rate Poor range resolution Poor velocity resolution

7 Range resolution Velocity resolution

8 Resolution of color Doppler study

9 Velocity Scale Change

10 Transducer Frequency Change

11 Pitfalls in assessing size
Normal size Large heart Small heart

12 Normal size What is normal ? Mean ± 2 SD
Growth parameters : gestational period, body weight, head circumference, height, etc Heart parameters : dimension, area, volume

13 Large Heart Right or left or both sides Causes
cardiac malformation valvular or ventricular dysfunction secondary to fetal diseases Effects on fetus; long-term effects

14 Small Heart Anatomic definition: diameter / area below - 2 SD ?
Functional definition : too small to be a ventricle Growth parameters : body weight > gestational age Any potential of catch up growth ?

15 How small? Too small: hardly seen, no potential of growth Questionable
Not too small: -2 ~ -3 SD, may have a potential

16 Too Small Heart Causes : HLHS, HRHS
How to assess : PFO, ductus, coronary fistula Counsel : single ventricle and Fontan

17 Not Too Small Causes: unknown, COA, AS, MS, PS etc
How to assess: complete study on heart / vessel Counsel : cautious optimism

18 An example of LV being ‘Not Too Small’

19 An example of LV being ‘Not Too Small’


21 Pitfall in Natural History
Newly diagnosed in the 3rd trimester Cardiac malformations become worse Cardiac defects / diseases become better

22 Newly diagnosed in the 3rd trimester
Cardiac malformation Cardiomyopathy Cardiac tumor Secondary cardiac disease

23 Natural History May get worse May get better May stay the same

24 Pitfalls in Arrhythmia
Technical pitfalls: difficult to obtain signal Interpretation: requires thorough knowledge Common mistake transient bradycardia intermittent premature contraction

25 M-mode is difficult to obtain

26 Poor Tracing: difficult to
Frequently Poor Tracing: difficult to identify wall motion ← Ventricular wall ← Mitral valve ← Atrial wall Occasionally Good Tracing : Atrial wall contraction precedes mitral valve closure and ventricular contraction

27 Premature Atrial Contraction

28 Brief bradycardia is common

29 Intermittent premature contraction is frequent

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