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