Echocardiographic Anatomy in the Fetus
Chiappa - Echocardiographic Anatomy in the Fetus-2008
PART I Basic Principles of Diagnosis
1 General Guidelines. 3
Introduction. 3
Equipment. 4
Major Planes of the Body and Heart. 6
Basic Probe Manipulations. 7
Axial and Lateral Resolution. 9
Method for Comprehensive Cardiac Evaluation. 10
References. 12
2 Determining the Laterality of the Fetal Body and Image Orientation. 15
Introduction. 15
Methods. 16
-Procedure. 17
Image Orientation. 19
Reference. 20
3 The Visceroatrial Arrangement Situs. 21
Introduction. 21
Usual Arrangement Situs Solitus. 21
Mirror-Image Arrangement Situs Inversus. 23
Left Isomerism Polysplenia. 24
Right Isomerism Asplenia. 26
References. 28
4 The Cardiac Position and Axis Orientation. 29
Introduction. 29
Heart in the Left Side of the Chest Levocardia. 30
Heart in the Middle of the Chest Mesocardia. 31
Heart in the Right Side of the Chest Dextrocardia. 31
Isomerism of the Atrial Appendages and Cardiac Position. 35
References. 37
5 Principles of Segmental Analysis. 39
Introduction. 39
The Atria. 39
The Ventricles. 40
The Arterial Trunks. 42
The Atrioventricular Connection. 42
The Ventriculoarterial Connection. 44
References. 48
PART II Echocardiographic Projections
Transverse Views of the Fetal Body
6 The Transverse Views of the Upper Abdomen. 51
Introduction. 51
The Umbilical Cord Insertion. 51
The Lower Liver. 52
The Mid Liver. 52
The Portal Sinus. 52
The Infracardiac Vena Cava. 55
The Suprahepatic Veins. 55
References. 57
7 The Four-Chamber View. 59
The Section Plane. 59
The Normal Morphology. 59
The Normal Echocardiogram — 2D. 60
Dimensions of the Heart. 63
Measurement. 63
Ventricular Function. 65
The Normal Echocardiogram — Color Flow Mapping and Pulsed Doppler. 65
— The Atrioventricular Valves. 65
-The Pulmonary Veins. 69
Cardiac Rhythm. 71
Ventricular Output. 71
Four-Chamber-View Checklist. 72
References. 74
8 The Five-Chamber View. 77
The Section Plane. 77
The Normal Morphology. 77
The Normal Echocardiogram — 2D. 77
The Normal Echocardiogram — Color Flow Mapping and Pulsed Doppler. 79
References. 86
9 The Three-Vessel View. 87
Introduction. 87
The Normal Morphology. 87
The Normal Echocardiogram — 2D. 88
The Normal Echocardiogram — Color Flow Mapping and Pulsed Doppler. 88
Three-Vessel-View Abnormalities. 89
Ascending Aorta and Pulmonary Artery Disproportion. 96
Aortic Arch Sidedness. 96
Relationship of the Great Arteries and Cardiac Connections. 96
References. 99
10 The Arterial Duct Transverse View. 101
The Section Plane. 101
The Normal Morphology. 101
The Normal Echocardiogram — 2D. 102
The Normal Echocardiogram — Color Flow Mapping and Pulsed Doppler. 102
Contents
The Arterial Duct — Reversed Flow. 103
The Arterial Duct — Short Length. 105
The Arterial Duct — Abnormal Shape. 105
The Arterial Duct — Premature Constriction or Closure. 108
The Arterial Duct — Abnormal Position. 110
References. 111
11 The Aortic Arch Transverse View. 113
The Section Plane. 113
The Normal Morphology. 113
The Normal Echocardiogram — 2D. 113
— The Thymus. 114
The Normal Echocardiogram — Color Flow Mapping and Pulsed Doppler. 115
Aortic Arch Abnormal Size. 116
Aortic Arch Interruption. 117
Aortic Arch Sidedness. 117
References. 121
12 The Arterial Duct and Aortic Arch Transverse View. 123
The Section Plane. 123
The Normal Morphology. 123
The Normal Echocardiogram — 2D. 123
The Normal Echocardiogram — Color Flow Mapping. 124
The Aortic Arch Abnormalities. 126
— Severe Aortic Outflow Obstruction. 126
— Severe Pulmonary Outflow Obstruction. 126
— Pseudoatresia of the Pulmonary Valve. 128
-Vascular Ring. 128
Azygos Vein Dilatation. 128
The Transverse Views of the Fetal Body an Overview. 129
References. 131
Longitudinal Views of the Fetal Body
13 The Inferior and Superior Vena Cava Long-Axis View The Bicaval View. 135
The Section Plane. 135
The Normal Morphology. 135
The Normal Echocardiogram — 2D. 137
The Normal Echocardiogram — Color Flow Mapping and Pulsed Doppler. 137
The Azygos Vein. 139
Vena Cava Disproportion. 139
Azygos Vein Dilatation. 139
References. 142
14 The Aortic Arch Long-Axis View. 143
The Section Plane. 143
The Normal Morphology. 143
The Normal Echocardiogram — 2D. 145
The Normal Echocardiogram — Color Flow Mapping and Pulsed Doppler. 146
The Aortic Arch Abnormalities. 148
— Severe Aortic Outflow Obstructions. 148
— Severe Pulmonary Outflow Obstructions. 149
-Variability of the Plane of the Aortic Arch Long-Axis View. 151
— The Aortic Arch in Mitral Valve Atresia with Ventricular Septal Defect. 151
References. 153
15 The Arterial Duct Long-Axis View. 155
The Section Plane. 155
The Normal Morphology. 155
The Normal Echocardiogram — 2D. 156
The Normal Echocardiogram — Color Flow Mapping and Pulsed Doppler. 157
Duct-Dependent Systemic Circulation. 159
Duct-Dependent Pulmonary Circulation. 159
The Arterial Duct — Premature Constriction or Closure. 162
References. 164
16 Special Considerations on the Arterial Duct and Aortic Arch Views. 165
Technique. 165
17 The Right Ventricle Outflow View. 169
The Section Plane. 169
The Normal Morphology. 169
The Normal Echocardiogram — 2D. 171
The Normal Echocardiogram — Color Flow Mapping and Pulsed Doppler. 171
18 The Left Ventricle Short-Axis View. 177
The Section Plane. 177
The Normal Morphology. 177
— The Level of the Mitral and Tricuspid Valves. 177
— The Level of the Papillary Muscles. 178
Oblique Views of the Fetal Body
19 The Left Ventricle Long-Axis View. 187
The Section Plane. 187
The Normal Morphology. 187
The Normal Echocardiogram — 2D. 189
The Normal Echocardiogram — Color Flow Mapping and Pulsed Doppler. 189
PART III Echocardiographic and Morphologic Overview
20 Three-Dimensional Ultrasound Assessment of the Fetal Heart. 199
Rabih Chaoui
Introduction. 199
Technical Principles of 3D 4D Fetal Echocardiography. 199
— Volume Acquisition. 199
Static 3D. 200
Real-Time 3D Direct Volume Scan Real Time Online 4D. 200
STIC Indirect Volume Scan, Motion Gated Off-Line 4D. 200
— Volume Display. 200
Planes One Plane, Multiplanar Orthogonal, and Multiplanar Tomography. 200
— Rendering. 201
Surface Mode. 201
Glass-Body Mode with Color Doppler. 203
Minimum Transparent and Inversion Mode. 208
Conclusion. 208
References. 210
21 The Role of the Pathologist in the Diagnosis of Fetal Heart Disease. 211
Introduction. 211
The Morphologic Study. 211
— Instrumentation. 211
— Exposure of the Heart and Great Vessels. 212
— Heart Examination In Situ. 212
— Removal of the Heart and Lung Block. 213
— Methods of Heart Dissection. 213
Dissection Following Blood Flow. 213
Tomographic Method. 213
Windowing the Heart. 216
New Technique for the Autopsy. 216
Description of Cardiovascular Defects. 217
Iconographic Documentation. 217
— Choice of Equipment. 218
— Lighting. 218
— Background. 218
— Image Quality. 218
— Exposure Time and Depth of Field. 219
Conclusion. 220
References. 221
Credits for Figures
Basic Principles of Diagnosis
1 General Guidelines. 3
Introduction. 3
Equipment. 4
Major Planes of the Body and Heart. 6
Basic Probe Manipulations. 7
Axial and Lateral Resolution. 9
Method for Comprehensive Cardiac Evaluation. 10
References. 12
2 Determining the Laterality of the Fetal Body and Image Orientation. 15
Introduction. 15
Methods. 16
-Procedure. 17
Image Orientation. 19
Reference. 20
3 The Visceroatrial Arrangement Situs. 21
Introduction. 21
Usual Arrangement Situs Solitus. 21
Mirror-Image Arrangement Situs Inversus. 23
Left Isomerism Polysplenia. 24
Right Isomerism Asplenia. 26
References. 28
4 The Cardiac Position and Axis Orientation. 29
Introduction. 29
Heart in the Left Side of the Chest Levocardia. 30
Heart in the Middle of the Chest Mesocardia. 31
Heart in the Right Side of the Chest Dextrocardia. 31
Isomerism of the Atrial Appendages and Cardiac Position. 35
References. 37
5 Principles of Segmental Analysis. 39
Introduction. 39
The Atria. 39
The Ventricles. 40
The Arterial Trunks. 42
The Atrioventricular Connection. 42
The Ventriculoarterial Connection. 44
References. 48
PART II Echocardiographic Projections
Transverse Views of the Fetal Body
6 The Transverse Views of the Upper Abdomen. 51
Introduction. 51
The Umbilical Cord Insertion. 51
The Lower Liver. 52
The Mid Liver. 52
The Portal Sinus. 52
The Infracardiac Vena Cava. 55
The Suprahepatic Veins. 55
References. 57
7 The Four-Chamber View. 59
The Section Plane. 59
The Normal Morphology. 59
The Normal Echocardiogram — 2D. 60
Dimensions of the Heart. 63
Measurement. 63
Ventricular Function. 65
The Normal Echocardiogram — Color Flow Mapping and Pulsed Doppler. 65
— The Atrioventricular Valves. 65
-The Pulmonary Veins. 69
Cardiac Rhythm. 71
Ventricular Output. 71
Four-Chamber-View Checklist. 72
References. 74
8 The Five-Chamber View. 77
The Section Plane. 77
The Normal Morphology. 77
The Normal Echocardiogram — 2D. 77
The Normal Echocardiogram — Color Flow Mapping and Pulsed Doppler. 79
References. 86
9 The Three-Vessel View. 87
Introduction. 87
The Normal Morphology. 87
The Normal Echocardiogram — 2D. 88
The Normal Echocardiogram — Color Flow Mapping and Pulsed Doppler. 88
Three-Vessel-View Abnormalities. 89
Ascending Aorta and Pulmonary Artery Disproportion. 96
Aortic Arch Sidedness. 96
Relationship of the Great Arteries and Cardiac Connections. 96
References. 99
10 The Arterial Duct Transverse View. 101
The Section Plane. 101
The Normal Morphology. 101
The Normal Echocardiogram — 2D. 102
The Normal Echocardiogram — Color Flow Mapping and Pulsed Doppler. 102
Contents
The Arterial Duct — Reversed Flow. 103
The Arterial Duct — Short Length. 105
The Arterial Duct — Abnormal Shape. 105
The Arterial Duct — Premature Constriction or Closure. 108
The Arterial Duct — Abnormal Position. 110
References. 111
11 The Aortic Arch Transverse View. 113
The Section Plane. 113
The Normal Morphology. 113
The Normal Echocardiogram — 2D. 113
— The Thymus. 114
The Normal Echocardiogram — Color Flow Mapping and Pulsed Doppler. 115
Aortic Arch Abnormal Size. 116
Aortic Arch Interruption. 117
Aortic Arch Sidedness. 117
References. 121
12 The Arterial Duct and Aortic Arch Transverse View. 123
The Section Plane. 123
The Normal Morphology. 123
The Normal Echocardiogram — 2D. 123
The Normal Echocardiogram — Color Flow Mapping. 124
The Aortic Arch Abnormalities. 126
— Severe Aortic Outflow Obstruction. 126
— Severe Pulmonary Outflow Obstruction. 126
— Pseudoatresia of the Pulmonary Valve. 128
-Vascular Ring. 128
Azygos Vein Dilatation. 128
The Transverse Views of the Fetal Body an Overview. 129
References. 131
Longitudinal Views of the Fetal Body
13 The Inferior and Superior Vena Cava Long-Axis View The Bicaval View. 135
The Section Plane. 135
The Normal Morphology. 135
The Normal Echocardiogram — 2D. 137
The Normal Echocardiogram — Color Flow Mapping and Pulsed Doppler. 137
The Azygos Vein. 139
Vena Cava Disproportion. 139
Azygos Vein Dilatation. 139
References. 142
14 The Aortic Arch Long-Axis View. 143
The Section Plane. 143
The Normal Morphology. 143
The Normal Echocardiogram — 2D. 145
The Normal Echocardiogram — Color Flow Mapping and Pulsed Doppler. 146
The Aortic Arch Abnormalities. 148
— Severe Aortic Outflow Obstructions. 148
— Severe Pulmonary Outflow Obstructions. 149
-Variability of the Plane of the Aortic Arch Long-Axis View. 151
— The Aortic Arch in Mitral Valve Atresia with Ventricular Septal Defect. 151
References. 153
15 The Arterial Duct Long-Axis View. 155
The Section Plane. 155
The Normal Morphology. 155
The Normal Echocardiogram — 2D. 156
The Normal Echocardiogram — Color Flow Mapping and Pulsed Doppler. 157
Duct-Dependent Systemic Circulation. 159
Duct-Dependent Pulmonary Circulation. 159
The Arterial Duct — Premature Constriction or Closure. 162
References. 164
16 Special Considerations on the Arterial Duct and Aortic Arch Views. 165
Technique. 165
17 The Right Ventricle Outflow View. 169
The Section Plane. 169
The Normal Morphology. 169
The Normal Echocardiogram — 2D. 171
The Normal Echocardiogram — Color Flow Mapping and Pulsed Doppler. 171
18 The Left Ventricle Short-Axis View. 177
The Section Plane. 177
The Normal Morphology. 177
— The Level of the Mitral and Tricuspid Valves. 177
— The Level of the Papillary Muscles. 178
Oblique Views of the Fetal Body
19 The Left Ventricle Long-Axis View. 187
The Section Plane. 187
The Normal Morphology. 187
The Normal Echocardiogram — 2D. 189
The Normal Echocardiogram — Color Flow Mapping and Pulsed Doppler. 189
PART III Echocardiographic and Morphologic Overview
20 Three-Dimensional Ultrasound Assessment of the Fetal Heart. 199
Rabih Chaoui
Introduction. 199
Technical Principles of 3D 4D Fetal Echocardiography. 199
— Volume Acquisition. 199
Static 3D. 200
Real-Time 3D Direct Volume Scan Real Time Online 4D. 200
STIC Indirect Volume Scan, Motion Gated Off-Line 4D. 200
— Volume Display. 200
Planes One Plane, Multiplanar Orthogonal, and Multiplanar Tomography. 200
— Rendering. 201
Surface Mode. 201
Glass-Body Mode with Color Doppler. 203
Minimum Transparent and Inversion Mode. 208
Conclusion. 208
References. 210
21 The Role of the Pathologist in the Diagnosis of Fetal Heart Disease. 211
Introduction. 211
The Morphologic Study. 211
— Instrumentation. 211
— Exposure of the Heart and Great Vessels. 212
— Heart Examination In Situ. 212
— Removal of the Heart and Lung Block. 213
— Methods of Heart Dissection. 213
Dissection Following Blood Flow. 213
Tomographic Method. 213
Windowing the Heart. 216
New Technique for the Autopsy. 216
Description of Cardiovascular Defects. 217
Iconographic Documentation. 217
— Choice of Equipment. 218
— Lighting. 218
— Background. 218
— Image Quality. 218
— Exposure Time and Depth of Field. 219
Conclusion. 220
References. 221
Credits for Figures
Basic Principles of Diagnosis