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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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476
Diagnosis
Dextrocardia and the transposition of the great arteries were
diagnosed.
Comment
Given the diagnosis of the transposition of the great arteries
and dextrocardia, delivery in an equipped center was recom-
mended. The neonate was born with cyanosis; the diagnosis
was the transposition of the great arteries and dextrocardia.
Despite undergoing a surgical operation, the neonate died in
the neonatal intensive care unit.
Case 144 Fetal Heart Echocardiography: Transposition of Great Arteries
477
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_145, © Springer International Publishing Switzerland 2015
A 27-year-old pregnant woman (6 months of pregnancy) was
referred for fetal heart echocardiography. Her fi rst pregnancy
had been terminated because of genetic abnormalities. She
and her husband were relatives.
Fetal Heart Echocardiography:
Single Ventricle
Case 145
ab
Fig. 145.1 A single ventricle ( arrow ) ( a ), a common atrium ( curved arrow ), and a common atrioventricular valve ( arrow head ) ( b ) are visualized
in fetal heart echocardiography
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_145 ) contains supplementary
material, which is available to authorized users.
478
Fig. 145.3 A single ventricle is confi rmed by another view ( arrow )
ab
cd
Fig. 145.2 There is a nonturbulent red fl ow across the common atrio-
ventricular valve ( arrow ) ( a ) and severe common atrioventricular valve
regurgitation in the short-axis view of fetal heart echocardiography
( curved arrow ) ( b ). The peak gradient across this regurgitation is
37 mmHg ( c ), and the fetal heart rate is 53 beats per minute ( d ), which
is severe bradycardia for a fetus
Diagnosis
The diagnosis of a single ventricle was established.
Comment
The fetus’s condition would require multiple surgeries after
its birth; accordingly, abortion was recommended.
Lesson
If there are anomalies for which there is no cure, the condition should be thoroughly explained to the parents. The termination of pregnancy seems logical.
Case 145 Fetal Heart Echocardiography: Single Ventricle
479
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_146, © Springer International Publishing Switzerland 2015
A 30-year-old pregnant woman (24 weeks of pregnancy) was
referred for fetal heart echocardiography.
Fetal Heart Echocardiography:
Ventricular Septal Defect
Inlet Type
Case 146
Fig. 146.1 An inlet ventricular septal defect ( arrow ) can be seen in
fetal heart echocardiography (four-chamber view)
Fig. 146.2 The bifurcation of the pulmonary artery is visualized in
fetal heart echocardiography (short-axis view) ( arrow )
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_146 ) contains supplementary
material, which is available to authorized users.
480
Diagnosis
Inlet ventricular septal defect
Comment
The patient was recommended for follow up echocardiography
a
b
Fig. 146.3 There is a nonturbulent bidirectional fl ow across the VSD in the four-chamber view ( red and blue ) ( a , b ) ( arrows )
Case 146 Fetal Heart Echocardiography: Ventricular Septal Defect Inlet Type
481
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_147, © Springer International Publishing Switzerland 2015
A 32-year-old woman was referred to us for fetal heart echo-
cardiography. Her fi rst child was 9 years old and completely
healthy. She was at 35 weeks of pregnancy, and all her
screening tests were normal.
Fetal Heart Echocardiography:
Atrioventricular Septal Defect
Case 147
a
b
Fig. 147.1 A common atrioventricular valve ( curved arrow ), an atrial
septal defect (ASD) (ostium primum type) ( arrowhead ), and a ventricu-
lar septal defect (VSD) ( arrow ) are seen in the apical four-chamber
view with ( a ) and without nomenclature ( b ). LA left atrium, LV left
ventricle, RA right atrium, RV right ventricle
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_147 ) contains supplementary
material, which is available to authorized users.
482
Fig. 147.2 The ASD (ostium primum type) ( arrow ) is clearly visual-
ized in the fetal heart right ventricular infl ow view
Fig. 147.3 There is a nonturbulent fl ow across the VSD ( arrow ) in this
view
Fig. 147.4 The left ventricle is relatively small in the apical four-
chamber view ( arrow )
Case 147 Fetal Heart Echocardiography: Atrioventricular Septal Defect
483
Diagnosis
There was a common atrioventricular valve and an atrioventricular septal defect.
Comment
The mother was at 35 weeks of pregnancy. Therefore, delivery in an equipped center was recommended to her.
Lesson
1. After 28 weeks of gestational age, the probability that the
newborn survives is high. Consequently, the mother
should be allowed to complete the duration of pregnancy,
after which period an intervention will be performed for
the newborn.
2. The relatively small left ventricle that this fetus had was
due to unbalanced ventricles. This condition sometimes
occurs when there is an atrioventricular septal defect.
a
b
Fig. 147.5 A common atrioventricular valve is visualized in diastole ( a ) and systole ( b ) in the apical four-chamber view ( curved arrow )
Case 147 Fetal Heart Echocardiography: Atrioventricular Septal Defect
485
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_148, © Springer International Publishing Switzerland 2015
A 31-year-old pregnant woman (25 weeks of pregnancy) was
referred to our center for fetal heart echocardiography. It was
her fi rst pregnancy, and there was no history of congenital
heart disease in her fi rst-degree relatives.
Fetal Heart Echocardiography:
Transposition of Great Arteries
Case 148
Fig. 148.1 The left ventricle, which is located posteriorly and is near
the stomach ( arrow ), is small (about 4 mm). The right ventricle is 6 mm
Fig. 148.2 The small left ventricle is also evident in the short-axis
view ( arrow ). LV left ventricle, RV right ventricle
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_148 ) contains supplementary
material, which is available to authorized users.
486
Diagnosis
The fetus was diagnosed with the transposition of the great
arteries and a VSD.
Comment
The fetus had other anomalies on fetal sonography (absence
of one upper arm). Accordingly, abortion was recommended
to the mother.
Lesson
1. The transposition of the great arteries is an anomaly
which commonly is not associated with other anoma-
lies and genetic disorders and is a nearly curable disease. As a result, abortion is not recommended routinely.
Nevertheless, in this rare case, which was associated
with other serious anomalies, abortion was the most
logical course of action. Extracardiac anomalies are less
frequent in infants with the transposition of the great
arteries [ 108 ].
2. In a fetus with the transposition of the great arteries, oxygenated blood enters the pulmonary artery and circulation. The pulmonary circulation always has a vasoreactive
response to oxygen, so less fl ow enters the pulmonary
artery and less fl ow passes through the duct and less fl ow
passes from the foramen ovale. In a fetus with the transposition of the great arteries, there is a small interatrial
communication (usually about one third of the interatrial
septum) and a small left atrium, left ventricle, and ductus
arteriosus. The oxygenated blood that passes via the duct
increases the weight of the adrenal cortex and the number
of the pancreatic islet cells [ 109 ].
The indications for fetal echocardiography include [ 156 ]:
1. Diabetes mellitus in the mother
2. History of congenital heart disease in parents or
siblings
3. Systemic lupus erythematosus in mother
4. Monoclonal twins or multiple gestations
5. Increased nuchal thickness or any other abnormalities in
fetal screening tests
6. Bradycardia or other arrhythmia in fetus
7. Maternal age >35 years
8. Exposure to teratogens
9. In vitro fertilization
10. Hydrops
Fig. 148.3 The great artery, which is connected to the left ventricle, is
divided. It is, therefore, the pulmonary artery ( arrow ). There is a small
ventricular septal defect (VSD) below the pulmonary valve ( curved
arrow ). LV left ventricle, RV right ventricle, PA pulmonary artery
Case 148 Fetal Heart Echocardiography: Transposition of Great Arteries
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