1. Fetal Echocardiography
Dr. A. K. KAPOOR
Specialist Cardiologist
MBBS, MD(Med), DM(Card)

2. What is Congenital Heart Defect?
Congenital heart defects occur during the development of the heart in pregnancy
Most common congenital anomaly (25%)
Affects almost 1 percent of all babies born – and 50 percent of babies with a CHD are seriously affected and will need treatment before 1 year old.

3. What is Fetal Echocardiography?
The use of ultrasound waves to investigate the fetal heart-the structure and action of the heart.

4. Multi-disciplinary Team

5. Fetal Circulation

6. Cardiac Embryology

8. Who all should undergo? High Risk Approach
FETAL
Abnormal 4C view
Extracardiac anomalies
GIT, Spina bifida
Chromosomal anomalies
Vacterl, Trisomies, Digeorge
Non immune hydrops
IVF/ICSI
Irregular Heart Beat
Increased First Trimester NT
Abnormal cardiac axis
MATERNAL
Maternal CHD
Maternal auto - immune disease
Teratogen exposure
Metabolic disorder
DM, PKU
Intra uterine Infections
FAMILIAL
Previous child with CHD
Paternal CHD
Mendelian Syndromes
TS, Noonan;s, Digeorge

9. Timing of Fetal Echocardiography
The best time to do a fetal cardiac exam is weeks Later exams may show anatomy better but might be difficult because of rib shadowing Adequate exam depends on fetal position and maternal habitus Some pathologies become obvious with fetal age

10. Fetal Circulation

11. Ultrasound Hand Movements

13. Normal Ultrasound Scan

15. Rate and Rhythm
The heart rate is usually /min, the rhythm is regular but transient bradycardia is normal in the 2nd trimester but not in the 3rd

17. Views and Windows

18. Four Chamber View

19. 5 Chamber Apical View

20. Lower end of septum Foramen ovale Flap of foramen ovale in LA
Atria
Lower end of septum
Foramen ovale
Flap of foramen ovale in LA

21. Foramen Ovale

23. Moderator band identifies right ventricle
Basic Fetal Cardiac Examination - Ventricles
Equal size
Intact septum
Moderator band identifies right ventricle

24. Basic Fetal Cardiac Examination – AV Values
Tricuspid valve inserted more apically than mitral
Both valves move freely

25. Extended basic cardiac examination
The outflow tracts are imaged by tilting the probe towards the fetal head
The great vessels should be of equal size and should cross at approximately 90° as they emerge from their respective ventricles

26. Outflow Tracts – RVOT/LVOT

28. LVOT

29. Aortic Arch

30. Ductal Arch

31. RVOT Short Access View

32. 4-C view with PD mitral flow

33. LVOT with PD flow

34. Echogenic Intracardiac Focus (EIF)
Can be seen in up to 6% of normal pregnancies
Highly operator and machine dependant
Associated with cardiac and extracardiac anomalies
Bilateral EIF is more significant

35. - 38Y, Female - Echogenic Focus - Normal Fetal Echo Study - Normal CV System
- 31Y, Female - Multiple Echogenic Focus - Had some evidence of down syndrome
- EC Defects – Complex
- Child Survived

36. Echogenic Intracardiac Focus (EIF)
Biventricular EIF are more significant this patient was 47XY
Normal nuchal translucency

37. Pericardial Effusion

38. Hypoplastic left heart
Single atrium
Large VSD

39. Tricuspid

40. 30 Y, Female - Chinese
First Child
Now Child is 1 Y
Fetal Echo

41. TOF

42. TOF Outflow Tract

43. Echocardiography - Tetralogy of Fallot

44. Endocardial Cushion Defect

45. Echocardiography - ECD

46. EBSTEIN ANAMOLY

47. Dextrocardia

48. Echocardiography - Pulmonary Stenosis

49. Echocardiography - Severe Aortic Stenosis

50. Echocardiography - Ventricular Septal Defects

56. WHAT IS ALL ABOUT?
Twin Heart

59. THANK YOU

61. Four Chamber View

62. LVOT/RVOT

63. Echogenic Intracardiac Focus

65. DIAGNOSTIC ACUMEN