Fetal Echocardiography

Scope & Future !

Dr Maitri Chaudhuri
Wockhardt Hospitals, Bangalore
Do We Need Fetal Echo?
 CHD accounts for 0.8 to 1% of all
live births
 50% of all lethal malformations in
fetus are CARDIAC

Congenital Heart Disease Most Common Cause of Death in Fetus

 What To Know?

 Cardiac development & abnormalities

 Fetal Physiology
 Alterations in fetal physiology with CHD
 Natural history of the lesion in fetal life &
later
 Cardiac anatomy in all projections
Cardiac Embryology
Week Length Event`
s mm
1-2 1.5 No heart or great vessel
4 2 Single median cardiac tube, ineffective
contraction
5 4 Bilobed atrium
5 4 Beginning of circulation
5 7.5 AV orifices, 3 chamber heart
6 8.5-13 Septum secundum, complete inferior
septum, divided truncus arteriosus,
7 20 4 chamber heart
Cardiac Size

20 week fetus’
heart compared
with an
American
quarter
Usual HR
120-160/min
Timing of Fetal Echo
 Transvaginal Route  Early exam
 Asearly as 8 to 9  Too small heart
weeks  Late exam
 Transabdominal  Rib shadowing
Route
 18-22 weeks
Indications for Fetal Echo

Maternal
Family history of CHD
1.Convulsions
2.Drugs(Lithium)
3.Infections(Rubella) Chromosomal Anomalies
1.Trisomy 21,13,18
4.Diabetes 2.Repeated abortions
5.Age of mother>35 3.Positive amniocentesis
4.USG –other system
malformation
 Fetal Echo

 Sensitivity 95%

 Specificity 91%
Assessment of Heart Rate and Sinus Rhythm
from Pulsed Doppler Fetal Echo
Fetal Circulation

Fetal circulation is
complex and different
from adult blood flows
with three major shunts:
Ductus venosus
Forman ovale
Ductus arterosus
Approach To Fetal Echo
Four Chamber View of Heart
Normal fetal 4 chamber view
RV RA

LV
LA
Examples of Abnormal
Four Chamber View
in Fetal Echo
Hypoplastic Left Heart

HLHS

Normal
Abnormal TV
Abnormal TV

Normal
Tricuspid Dysplasia & severe TR
Endocardial Cushion Defect

ECD

Normal
Ebstein’s Anomaly

Downward displacement of
Septal Leaflet of TV
Abnormal TV
Severe TR
Huge RA
Small functional RV
Fetal rhabdomyoma
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
 Limitations of the 4 chamber
view
 Does not
profile outflows
 Sensitivity
 10-80%
Transducer position – Variable
Rotate anti-clock wise and tilt anteriority to vie the great
arteries
[5c, aorta n PA]
Abnormalities using Sweep
technique

TGA
Impact of Fetal Echo
• Complex CHD
 ? Termination

• Serious heart disease

 Delivery in tertiary centre
 Planned intervention

• Counseling
 Parental education
 Family support and preparedness

• ?? Fetal intervention