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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5761_Библиотеки_им_академика_М_И_Перельмана
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463
Diagnosis
There was a normal structural fetal heart echocardiography
[ 151 , 152 ].
ab
c
Fig. 139.6 The long-axis view of the aorta shows the left atrium, left ventricle, and aorta ( a ), with nomenclature and without it ( b ). The color fl ow
is toward the aorta ( c ). LA left atrium, LV left ventricle, RV right ventricle, AO aorta
Fig. 139.7 The fetal heart rate is equal to 150 beats per minute
Case 139 Fetal Heart Echocardiography of Twins
465
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_140, © Springer International Publishing Switzerland 2015
A 36-year-old woman was referred to our echocardiography
laboratory.
Fetal Heart Echocardiography:
Ventricular Septal Defect
Case 140
Fig. 140.1 There is a small ventricular septal defect (VSD) by two-dimensional echocardiography ( a ) and the color-fl ow study ( arrow ) ( b ) in the
subcostal four-chamber view. LV left ventricle, RV right ventricle
Fig. 140.2 The VSD lies just below the aortic valve and is, thus, a
perimembranous type, in the apical fi ve-chamber view. LV left ventri-
cle, AO aorta
Diagnosis
There was a small perimembranous VSD.
Comment
Only echocardiography after birth for the infant was recommended because many small VSDs tend to close spontaneously during pregnancy with increased gestational age
especially muscular types [ 75 , 156 ].
Lesson
Given that the resistance of the systemic circulation and the
pulmonary vascular circulation is equal in the fetus, the fl ow
of the VSD is nonturbulent.
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_140 ) contains supplementary
material, which is available to authorized users.
467
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_141, © Springer International Publishing Switzerland 2015
A 30-year-old pregnant woman (gestational age of 25 weeks)
with a history of previous fetal cardiac anomaly was referred
for fetal heart echocardiography.
Fetal Heart Echocardiography
Focusing Ductal Arch
and Aortic Arch
Case 141
a
b
Fig. 141.1 The ductal view shows the right ventricular outfl ow tract,
main pulmonary artery, ductus arteriosus, and descending aorta. Purple
( b ) and 1 ( a ), right ventricular outfl ow tract; orange , main pulmonary
artery ( b ) and 2 ( a ); green , ductal arch ( b ) and 3 ( a ); red , descending
aorta ( b ) and 4 in ( a )
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_141 ) contains supplementary
material, which is available to authorized users.
468
Diagnosis
There was a normal structural fetal heart echocardiography.
Lesson
The ductal arch is in continuity with the pulmonary artery
and the right ventricular outfl ow tract. It is less curved relative to the aortic arch and has no branches [ 152 , 156 ].
a
b
Fig. 141.3 This is the sagittal view of the aortic arch and the ductus arteriosus ( a , b ). ( a ) 1 ascending aorta; 2 ductus arteriosus; ( b ) red , aortic
arch; blue , ductus arteriosus; DAO descending aorta
Fig. 141.2 The apical position of the right atrioventricular valve
( arrow ) shows that it is indeed the tricuspid valve. RA right atrium, RV
right ventricle
Case 141 Fetal Heart Echocardiography Focusing Ductal Arch and Aortic Arch
469
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_142, © Springer International Publishing Switzerland 2015
A 25-week pregnant woman with a familial history of
congenital heart disease was referred to our echocardiography laboratory for fetal heart echocardiography.
Fetal Heart Echocardiography
by Four-Dimensional
Reconstruction
Case 142
Fig. 142.1 The four cardiac
chambers are well developed.
The moderator band, located in
the right ventricle ( arrowhead ),
shows the right ventricle in this
four-dimensional reconstruction
(subcostal four-chamber view)
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_142 ) contains supplementary
material, which is available to authorized users.
470
Fig. 142.2 The left atrial
appendage ( arrowhead ) is
attached to the left atrium, and
the pulmonary veins (two yellow
arrows ) drain into this atrium
Fig. 142.3 The interatrial septal
defect size is approximately one
third of the interatrial septum,
which is a normal fi nding in a
fetus ( arrowhead ). RA right
atrium, RV right ventricle, LAA
left atrial appendage, LV left
ventricle
Case 142 Fetal Heart Echocardiography by Four-Dimensional Reconstruction
471
Diagnosis
This case was a normal structural fetal heart echocardiography.
Fig. 142.5 The multiplane modality of a four-dimensional probe depicts the fetal heart in the subcostal four-chamber, three-chamber, and modi-
fi ed two-chamber views
Fig. 142.4 The fetal heart rate is about 148 beats per minute
Case 142 Fetal Heart Echocardiography by Four-Dimensional Reconstruction
473
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_143, © Springer International Publishing Switzerland 2015
A 32-year-old woman was referred to our center for fetal
heart echocardiography.
Fetal Heart Echocardiography
Focusing Branching of Main
Pulmonary Artery
Case 143
Fig. 143.1 The short-axis view of fetal heart echocardiography shows
the main pulmonary artery, right pulmonary artery, and ductus arteriosus. MPA main pulmonary artery, RPA right pulmonary artery, DA duc-
tus arteriosus
a
b
Fig. 143.2 The apical four-chamber view of the fetus shows situs soli-
tus. If we draw a line between the spine and the sternum, the right
atrium and the right ventricle, which are slightly larger than the left
atrium and the left ventricle, lie on the right side of this line ( a ). The
apical fi ve- chamber view depicts the origin of the aorta from the left
ventricle ( b ). LA left atrium, LV left ventricle, RA right atrium, RV right
ventricle, AO aorta
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_143 ) contains supplementary
material, which is available to authorized users.
474
Diagnosis
There was a normal structural fetal heart echocardiography.
Fig. 143.4 The fetal heart rate is about 149 beats per minute
a
b
Fig. 143.3 The parasternal long-axis view of the fetus demonstrates the continuity of the mitral and aortic valves by two-dimensional ( a ) and
color Doppler echocardiography ( b ). LA left atrium, LV left ventricle, AO aorta, RV right ventricle
Case 143 Fetal Heart Echocardiography Focusing Branching of Main Pulmonary Artery
475
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_144, © Springer International Publishing Switzerland 2015
A 22-year-old pregnant woman (gravida 2, para 1) was
referred to our clinic for fetal heart echocardiography at
18 weeks of pregnancy. It was her second pregnancy, and her
fi rst baby had died 3 days after birth of an unknown cause.
She and her husband were relatives (fi rst cousins), and there
was no history of congenital heart disease in their family.
Fetal Heart Echocardiography:
Transposition of Great Arteries
Case 144
a
b
Fig. 144.1 The subcostal fi ve-chamber view of the fetus shows that the
heart lies on the right side of the thorax. (If we draw a line between the
vertebral column [ arrow ] and the sternum [ curved arrow ], the heart’s
position is on the right side of this line.) Thus, the fetus has dextrocardia
( a ). The left atrium connects to a relatively small left ventricle. The left
ventricle connects to a great vessel which is bifurcated and is, therefore,
the pulmonary artery. The right atrium connects to the right ventricle.
The ratio of the right system to the left system is great for the gestational age ( b ). LA left atrium, RA right atrium, LV left ventricle, RV right
ventricle, PA pulmonary artery
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_144 ) contains supplementary
material, which is available to authorized users.
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