Ultrasound Link - fetal heart

Left atrial isomerism with congenital heart block

Mon, 12 Nov 2012 23:53:51 GMT

This video clip demonstrates left atrial isomerism (LAI) with congenital heart block in the fetus at 13 weeks' gestation.

LAI is one of the types of heterotaxy syndrome or situs ambiguous. The classical sonographic features of left atrial isomerism, which is also called polysplenia syndrome, are:

atrioventricular septal defect (AVSD) or other congenital heart defects
congenital heart block
interrupted inferior vena cava with azygous continuation
right-sided stomach

Right aortic arch at 11-13 weeks of pregnancy

Mon, 15 Oct 2012 18:16:43 GMT

This video clip describes ultrasound features of right aortic arch at 11-13 weeks.

Right aortic arch represents an anatomical variant of the aortic arch development. This condition is usually benign, however it can be associated with other cardiac defects, vascular constriction rings and DiGeorge syndrome. Sonographic finding in right aortic arch is unusual three-vessel and trachea view. In normal three-vessel and trachea view aortic and ductal arches form shape connection, known as V-sign. In right aortic arch the arches are parallel and they have blunt connection, forming U-sign. The trachea is located between the arteries.

Tetralogy of Fallot (TOF) ultrasound diagnosis at 11 weeks

Sun, 07 Oct 2012 13:02:54 GMT

This video clip describes ultrasound features of tetralogy of Fallot (TOF) in a fetus at 11 weeks of pregnancy.

Tetralogy of Fallot by definition represents a common combination of four different heart anomalies: a VSD, pulmonary stenosis, an overriding aorta and right ventricular hypertrophy. During fetal life in utero right ventricular hypertrophy is not present and the congenital heart defect consists from three abnormalities:

Ventricular septal defect (VSD)
Overriding aorta
Pulmonary infundibular stenosis or pulmonary valve (valvular) stenosis

In presented case of TOF echo the classical combination of anomalies was diagnosed at 11 weeks 2 days (CRL = 46 mm). 4D echocardiography with spatio-temporal image correlation (STIC) and tomographic ultrasound imaging (TUI) assisted in the diagnosis. The fetus had normal nuchal translucency (NT) thickness of 1.5 mm. The diagnosis of TOF was confirmed by repeated fetal echocardiogram at 13 weeks.

Coarctation of the aorta at 12 and 13 weeks' gestation

Sun, 30 Sep 2012 15:55:04 GMT

This video clip describes echocardiographic features of coarctation of the aorta in fetus at 12 and 13 weeks of pregnancy

Coarctation of the aorta is difficult to detect at 11-13 weeks scan.

The fetus had cystic hygroma, bilateral hydrothorax and severe skin edema. At 12 weeks' gestation there were very mild ventricular disproportion right ventricle (RV) > left ventricle (LV) and narrowing of the aorta. Blood flow in aorta was poor visible. There was also aberrant right subclavian artery (ARSA). Repeated fetal echo at 13 weeks (one week later) confirmed aortic arch hypoplasia. It was very difficult to see continuation of the aorta after branching of ARSA.

An additional findings in the fetus were persistent left superior vena cava (PLSVC) and aberrant right subclavian artery (ARSA). PLSVC can be normal variation of the upper thoracic venous system, however it is very frequently associated with other cardiac anomalies. ARSA is also common anatomical variant, however its presence increases the risk for Downs syndrome and other chromosomal anomalies.

The clue for the first trimester diagnosis of coartation of the aorta is the RV>LV disproportion, which can be very mild (as in the case presented). All the cases RV>LV disproportion at 11-13 weeks need to be followed-up in order to exclude further development of coarctation.

Ventricular septal defect (VSD): difficult diagnosis at 11-13 weeks

Sun, 23 Sep 2012 16:44:59 GMT

This video clip describes echocardiographic features of ventricular septal defect (VSD) in fetus at 13 and 12 weeks' gestation.

VSD can be very difficult to detect and it can be easily not diagnosed even at 20 weeks scan.

The fetus has mildly increased nuchal translucency (NT) thickness. At 12 weeks' gestation there was ventricular disproportion (RV>LV) on fetal echocardiography and a congenital heart defect (CHD) was suspected. It was not possible to visualize ventricular septal defect at that stage. Repeated fetal echo at 13 weeks (one week later) clearly demonstrated subaortic VSD. Overriding aorta was more committed to the left ventricle. Both great arteries had similar size.

This type of VSD is frequently seen in the fetuses with trisomy 18 and trisomy 13. It worth to mention again that the diagnosis of this CHD can be very difficult, because in many cases 4 chamber view and 3 vessel-trachea view are normal.

An additional finding in the fetus was persistent left superior vena cava (PLSVC) which was the anatomical variant of bilateral SVC. PLSVC can be normal variation of the upper thoracic venous system, however it is very frequently associated with other cardiac anomalies.

Tricuspid regurgitation (TR) in fetus: tricuspid dysplasia at 12 weeks of pregnancy

Sun, 16 Sep 2012 07:48:37 GMT

This video clip describes sonographic features of tricuspid valve dysplasia at 12 weeks gestation.

The fetus with increased nuchal translucency thickness and hydrops fetalis had congenital tricuspid valve dysplasia:

severe tricuspid regurgitation (TR)
normal attachment of septal tricuspid valve leaflet
right atrial enlargement
cardiomegaly
mild pericardial effusion

In this case severe fetal TR was visible even of 2D scan. Color flow regurgitation jet of the valve was massive and there was aliasing. The TR in fetus was holosystolic. Regurgitation velocity on pulsed-wave doppler echocardiography was 150 cm/s. Normal attachment of septal tricuspid valve leaflet was clearly visible. In Ebstein's anomaly, another form of congenital tricuspid valve disease, there is apical displacement of the septal and posterior tricuspid valve leaflets.

Hypoplastic left heart syndrome (HLHS) at 12 weeks of pregnancy

Fri, 14 Sep 2012 17:21:09 GMT

This training video illustrates sonographic features of hypoplastic left heart syndrome (HLHS) at 12 weeks' gestation.

In the presented example the HLHS complex includes:

Aortic atresia
Obliterated left ventricle
Mitral atresia
Enlarged right ventricle
Large pulmonary artery
Retrograde flow from the ductus arteriosus in the aortic arch
Patent foramen ovale with normal forward flow in the pulmonary veins

An additional finding was large azygos vein, draining into superior vena cava and normal (not interrupted) inferior vena cava

Double outlet right ventricle (DORV) at 13 weeeks of pregnancy

Sun, 02 Sep 2012 09:48:45 GMT

This video clip describes sonographic features of double outlet right ventricle (DORV) at 13 weeks gestation.

In the case presented there is complex heart defect which includes:

Subaortic VSD
Overriding aorta
Aorta more committed to the right ventricle (RV), than to the left ventricle (LV)
Parallel arrangement of the great arteries
Abnormal 3 vessel view with single great artery visible: enlarged aortic arch
Mild ventricular disproportion (RV>LV)
Mild disproportion of the great arteries: aorta > pulmonary artery
Mild pericardial effusion

Pericardial effusion at 11-13 weeks' gestation

Sun, 19 Aug 2012 18:02:51 GMT

This ultrasound video clip describes sonographic features of pericardial effusion at 11-13 weeks of pregnancy.

Acardiac twin (TRAP sequence) at 10 weeks' gestation

Tue, 17 Jul 2012 20:34:00 GMT

This video clip demonstrates monochorionic diamniotic (MCDA) twin pregnancy with acardiac twin at 10 weeks’ gestation. This rare condition is also known as Twin Reversed Arterial Perfusion Sequence (TRAP Sequence). The pump twin has heart failure with severe cardiomegaly and marked skin edema.

Transposition of the great arteries (TGA) at 13 weeks' gestation

Sun, 08 Jul 2012 18:59:46 GMT

This video clip demonstrates sonographic features of transposition of the great arteries (TGA) at 13 weeks of pregnancy.

The 12 Weeks Scan: 3D and 4D Ultrasound

Tue, 19 Jun 2012 21:21:07 GMT

This video demonstrates application of 3D and 4D ultrasound for early pregnancy anomaly scan at 11-13 weeks' gestation.

The clip illustrates the use of different 3D/4D techniques for assessment of fetal anatomy in the first trimester of pregnancy.

Surface rendering mode is used for examination of the fetal body, face and extremities.
3D multiplanar reconstruction, tomographic ultrasound imaging (TUI), omniview and 3D inversion mode are utilized for first trimester transvaginal neurosonography and for storing and examination of the fetal volume data.
Spatio-temporal image correlation (STIC) is the cornerstone of the 4D fetal echocardiography. STIC volume data can be presented in rendering mode, multiplanar reconstruction or TUI. 4D fetal echocardiography can utilize grey scale, color Doppler, power Doppler, inversion mode and other different modalities.
STIC sonoandiography with color Doppler rendering and glass body technique is applied for examination of fetal vascular system.
Virtual organ computer-aided analysis (VOCAL) is used for calculation of the volumes of different fetal structures.

For 3D/4D ultrasound training please contact fred@ultrasoundlink.com.

Ectopia cordis: pentalogy of Cantrell

Sun, 27 May 2012 15:48:47 GMT

This video clip demonstrates sonographic features of ectopia cordis at 12 weeks of pregnancy. In this case ectopia cordis is a part of the pentalogy of Cantrell.

Early fetal echo: 31 clips of normal fetal heart (compilation)

Sun, 20 May 2012 14:33:42 GMT

This is a training video about the first trimester fetal echocardiograpy. The compilation video consists of 31 short clips from 18 patients scanned at 11-13 weeks of pregnancy due to high risk for congenital heat disease (CHD). All presented cases had normal heart anatomy, which was confirmed by 20 week fetal echocardiography.

The indications for early pregnancy fetal echocardiography include:

Increased nuchal translucency thickness
Tricuspid regurgitation
Reversed a-wave in ductus venosus
Extracardiac anomaly, such as exomphalos
Previous pregnancy complicated by fetal CHD

All the scans were performed using a Voluson 730 ultrasound scanner. In the video every clip is played twice. In order to provide the viewer with the real experience of heart scanning the clips are not annotated. For an annotated training video of fetal echocardiography please refer to our post ‘Fetal echocardiography at 11-13 weeks of pregnancy’.

Abbreviations:

3VTV – three vessel-trachea view
4CV – four chamber view
LOT – left outflow tract
ROT – right outflow tract
Ao – aortic arch
Da – ductus arteriosus
PV – pulmonary valve
SVC – superior vena cava
RSA – right subclavian artery

Atrioventricular septal defect (AVSD) at 11 wks of pregnancy

Sun, 01 Apr 2012 14:57:17 GMT

This video clip demonstrates atrioventricular septal defect (AVSD) in the fetus with Down’s syndrome at 11 weeks' gestation.

AVSD, which comprises about 5% of congenital heart defects in infants, is strongly associated with trisomy 21. Another association of AVSD is with left atrial isomerism.

The classical sonographic feature of AVSD is absence of the crux or linear insertion of the atrioventricular (AV) valves. The presented case demonstrates a major defect of the AV septum and severe abnormality of the common AV valve. Color Doppler mapping with demonstration of abnormal not parallel filling of both ventricles through AVSD is essential in making the diagnosis in the first trimester. The condition is associated with severe holosystolic regurgitation, which is visible by colour Doppler as a jet with aliasing. Pulse Doppler is used for confirmation of regurgitation and for assessment of its severity.

Fetal echocardiography at 11-13 weeks of pregnancy

Sun, 22 Apr 2012 07:53:29 GMT

This is a transvaginal ultrasound video clip demonstrating examination of the fetal heart (echocardiography) at 13 weeks' gestation.

Major cardiac defects are responsible for about 50% of deaths in neonates and infants from all congenital abnormalities. It is therefore important to identify such defects as early in pregnancy as possible.

Early pregnancy echocardiography, performed at 11- 13 weeks' gestation, is used for screening and diagnosis of congenital heart defects. This is particularly important in the management of fetuses with increased nuchal translucency (NT) thickness.

Other indications include for early echocardiography include family history of congenital heart defects, detection of extracardiac defects, such as exomphalos or diaphragmatic hernia and the abnormal Doppler findings of reversed a-wave in the ductus venosus and tricuspid regurgitation.

Echocardiography: Increased NT and normal heart at 11 weeks

Sun, 22 Apr 2012 08:01:13 GMT

This is a transvaginal video clip demonstrating examination of the fetal heart (echocardiography) at 11 weeks' gestation. The nuchal translucency (NT) thickness was increased at 11 weeks but the fetal karyotype and heart were normal. The stomach was not visible at 11 weeks but it became visible at 13 weeks. The increased NT resolved over the next 2 weeks, the pregnancy progressed normally and a normal neonate was born at term.

Early pregnancy echocardiography, performed at 11- 13 weeks' gestation, is important for screening and diagnosis of congenital heart defects in fetuses with increased NT and normal karyotype. For further information about the relation of nuchal translucency thicknes and fetal outcome please refer to our post "Increased nuchal translucency (NT) and fetal outcome".