胎儿的循环系统(英文版)VIP免费

FetalCardiologyFetalCardiologyKottlerNE,LeopoldGR,O’BoyleKottlerNE,LeopoldGR,O’BoyleM,PretoriusD,SirlinCBM,PretoriusD,SirlinCBFetalCardiology•Cardiacanomaliesarethemostfrequentlyoverlookedgroupofabnormalities•Congenitalheartdisease=0.8%ofallpregnancies4%onesiblingaffected;10%twosiblingsaffected9%fatheraffected12%motheraffected•Causes>50%deathsfromcongenitaldiseaseFetalCardiology•RiskFactorsforcongenitalheartdisease:FamilyhistoryRecurrencerisk(hypoplasticleftheartashighas13.5%)NongestationalDMMaternalinfection(rubella)LupusDrugs(anticonvulsants,etoh,amphetamines,ocp,vitA,steroids,etc.)FetalCardiology•AIUM/ACRstandardsinthe2ndand3rdtrimestersinclude:FourchamberviewPositionoffetalheartinthethorax•LVOTandRVOTnotyetpartofstandards•4chamberviewalone:33-63%sensitive•Withoutflowtracts:83-85%sensitive[2]GOALS•Reviewnormalcardiacanatomyanditssonographicappearance(fourchamber,LVOT,RVOT)•Explorediagnosticpitfalls•ReviewtheappearanceofmorecommonstructuralcardiacdefectsTheFourChamberView1.HeartfillsonethirdofthechestTheFourChamberView2.Apexpointstotheleft(45degreeangle)TheFourChamberView3.SizeofrightchambersapproximatesleftchambersTheFourChamberView1.MVandTVmoveonrealtimeimaging4.VentricularseptumsymmetricTheFourChamberView6.Portionoftheatrialseptumpresent(crus)LeftVentricularOutflowTract•Identify:LV,RV,IVseptum,aorta(normalcaliber),+/-LA,+/-RA•MedialwalloftheascendingaortamergeswiththetopoftheIVseptum(mostfrequentlocationforVSD)•Pathology:VSD,tetralogyofFallot,transposition,truncusarteriosusRightVentricularOutflowTract•Identify:branchingofthemainPAintorightPAandductusarteriosus(todescAorta),ascaortaincrosssection,descaortatoleftofspine;verifyPAcrossesanteriortoascaorta•Pathology:transposition,truncusarteriosusSpineSpLeftAtriumRightAtriumLeftVentricleRightVentricleModeratorBandForamenOvaleFourChamberInterventricularSeptumLeftAtriumLeftVentricleRightVentricleAortaMitralValve(closed)AorticValve(open)InterventricularSeptumLeftVentricularOutflowTractRightVentricularOutflowTractRightAtriumRightVentricleMainPulmonaryArteryRightPulmonaryArteryDuctusArteriosusAscendingAortaAoTricuspidValvePulmonicValve(open)DescendingAortadAoSpPitfalls:PseudoVSD•WhentheIVseptumparallelstheUSbeam,resultantechodropoutlookslikeVSD•IVseptumnormallytapersneartheAVvalves•CorrectedbychangingtheangleofviewIVseptumparallelsUSbeam(echodropout)ChangingAnglePericardialeffusion???NO!!!Normalamountfluid(<2mm)PericardialEffusion???NO!!!Thehypoechoicmyocardiumextendsintotheinterventricularseptum(arrow),allowingdifferentiationfromapericardialeffusionEchogenicfoci:EFLV,EFRV•Weakassociationwithcardiacabnormalities•DoublestheriskforTrisomy21•Canbeconfusedwithportionsofthechordaetendinae(differentiateonrealtimeimaging)LALARAPathology•VSD•Tetralogyoffallot•Endocardialcushiondefect•Transpositionofthegreatvessels•Hypoplasticleftheart•Hypoplasticrightheart•Doubleoutletrightventricle•Truncusarteriosus•Ebsteinanomaly•CoarctationoftheaortaVentricularSeptalDefect(VSD)•Mostfrequentcardiacdefect(20-30%)[4]•IVseptum:inlet,trabecular,infundibularandmembranousportions(muscularandmembranous)•Maldevelopmentofmuscularseptumorendocardialcushion;improperresorptionofthemuscularridge•LefttorightshuntVSD4ChamberView4ChamberViewLVOTVSD4ChamberLVOTVSDRV4Chamber4ChamberLVOTVSD4ChamberColor(lef...