First and Early Second Trimester Diagnosis of Fetal Heart Disease 성균관의대 소아과...
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Transcript of First and Early Second Trimester Diagnosis of Fetal Heart Disease 성균관의대 소아과...
![Page 1: First and Early Second Trimester Diagnosis of Fetal Heart Disease 성균관의대 소아과 삼성제일병원 진단방사선과 민 지 연.](https://reader035.fdocuments.net/reader035/viewer/2022070407/56649e4c5503460f94b41938/html5/thumbnails/1.jpg)
First and Early Second Trimester Diagnosis of
Fetal Heart Disease
성균관의대 소아과삼성제일병원 진단방사선과
민 지 연
![Page 2: First and Early Second Trimester Diagnosis of Fetal Heart Disease 성균관의대 소아과 삼성제일병원 진단방사선과 민 지 연.](https://reader035.fdocuments.net/reader035/viewer/2022070407/56649e4c5503460f94b41938/html5/thumbnails/2.jpg)
Early confirmation of normal cardiac anatomy
Further testing, such as karyotyping Pharmacologic therapy Planned delivery Reduce early morbidity and mortality Earlier and safer termination
Benefits of Early Fetal ECHO
![Page 3: First and Early Second Trimester Diagnosis of Fetal Heart Disease 성균관의대 소아과 삼성제일병원 진단방사선과 민 지 연.](https://reader035.fdocuments.net/reader035/viewer/2022070407/56649e4c5503460f94b41938/html5/thumbnails/3.jpg)
Sonoembryology & Embryography
Heart beat; 6 wks (CRL 5.5 mm) Septa, arterial & venous connection; after 8 wks The mitral and tricuspid valve; 9-10 wks
7.5 wksCRL; 1.5 cm
![Page 4: First and Early Second Trimester Diagnosis of Fetal Heart Disease 성균관의대 소아과 삼성제일병원 진단방사선과 민 지 연.](https://reader035.fdocuments.net/reader035/viewer/2022070407/56649e4c5503460f94b41938/html5/thumbnails/4.jpg)
Aorta; end of 9 wks, larger than PA AP position of IVS; prior to 11 wks Brachiocephalic & carotid arteries; 12 wks
Sonoembryology & Embryography
sp sp
11.5 wksCRL; 5.8 cm
![Page 5: First and Early Second Trimester Diagnosis of Fetal Heart Disease 성균관의대 소아과 삼성제일병원 진단방사선과 민 지 연.](https://reader035.fdocuments.net/reader035/viewer/2022070407/56649e4c5503460f94b41938/html5/thumbnails/5.jpg)
LVOT, RVOT, Aortic arch with arterial duct; 13 wks Complete four-chamber view; 13-14 wks (12 wks)
Sonoembryology & Embryography
13.4 weeksCRL; 7 cm
sp
sp
![Page 6: First and Early Second Trimester Diagnosis of Fetal Heart Disease 성균관의대 소아과 삼성제일병원 진단방사선과 민 지 연.](https://reader035.fdocuments.net/reader035/viewer/2022070407/56649e4c5503460f94b41938/html5/thumbnails/6.jpg)
Transvaginal Ultrasonography
5-9 MHz Transvaginal probe 11-14 wks For fetal heart
11-14 weeks, TVS 15-18 weeks,
TVS=TAS > 18 weeks, TAS
TAS
TVS
![Page 7: First and Early Second Trimester Diagnosis of Fetal Heart Disease 성균관의대 소아과 삼성제일병원 진단방사선과 민 지 연.](https://reader035.fdocuments.net/reader035/viewer/2022070407/56649e4c5503460f94b41938/html5/thumbnails/7.jpg)
Early diagnosis of CHD Complex cardiac anomalies Lesions with early chamber disproportion Defects that are significant in size and/or
severity Limitation
Small size Difficulties in spatial orientation Limited range of imaging planes
transabdominal sonography in 2nd trimester
Transvaginal Ultrasonography
![Page 8: First and Early Second Trimester Diagnosis of Fetal Heart Disease 성균관의대 소아과 삼성제일병원 진단방사선과 민 지 연.](https://reader035.fdocuments.net/reader035/viewer/2022070407/56649e4c5503460f94b41938/html5/thumbnails/8.jpg)
Situs solitusDextrocardiaCorrected TGAFunctional single ventriclePulmonary stenosis
13 weeksCRL; 8 cm
![Page 9: First and Early Second Trimester Diagnosis of Fetal Heart Disease 성균관의대 소아과 삼성제일병원 진단방사선과 민 지 연.](https://reader035.fdocuments.net/reader035/viewer/2022070407/56649e4c5503460f94b41938/html5/thumbnails/9.jpg)
R
L
sp
12 weeks, CRL; 6 cm NT; 4 mm
MesocardiaRight Isomerism
![Page 10: First and Early Second Trimester Diagnosis of Fetal Heart Disease 성균관의대 소아과 삼성제일병원 진단방사선과 민 지 연.](https://reader035.fdocuments.net/reader035/viewer/2022070407/56649e4c5503460f94b41938/html5/thumbnails/10.jpg)
ST
R
L
sp
R
Lsp
12.5 weeksTOF
![Page 11: First and Early Second Trimester Diagnosis of Fetal Heart Disease 성균관의대 소아과 삼성제일병원 진단방사선과 민 지 연.](https://reader035.fdocuments.net/reader035/viewer/2022070407/56649e4c5503460f94b41938/html5/thumbnails/11.jpg)
Non-invasive first trimester US screening
Fluid collection at back of neck measured
11-14 wks
Nuchal Translucency (NT)
![Page 12: First and Early Second Trimester Diagnosis of Fetal Heart Disease 성균관의대 소아과 삼성제일병원 진단방사선과 민 지 연.](https://reader035.fdocuments.net/reader035/viewer/2022070407/56649e4c5503460f94b41938/html5/thumbnails/12.jpg)
Combination of maternal age & NT; 80% detection rate for Down syndrome at 5% false positive rate
Prevalence higher than normal Major cardiac defects Diaphragmatic hernia Exomphalos Body stalk anomaly Fetal akinesia
Nuchal Translucency Screening
![Page 13: First and Early Second Trimester Diagnosis of Fetal Heart Disease 성균관의대 소아과 삼성제일병원 진단방사선과 민 지 연.](https://reader035.fdocuments.net/reader035/viewer/2022070407/56649e4c5503460f94b41938/html5/thumbnails/13.jpg)
29,154 fetuses with normal chromosomes
Prevalence of major cardiac defects< 95th percentile 0.8> 95th percentile-3.4 mm 5.33.5-4.4 mm 28.94.5-5.4 mm 90.9> 5.5 mm 195Total 1.7 per 1000
NT & Cardiac Defects
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NT, Possible Mechanism
Cardiac failure not supported by range of CHD
no evidence in 2nd trimester of heart failure
BUT myocardial dysfunction in the 1st trimester?
![Page 15: First and Early Second Trimester Diagnosis of Fetal Heart Disease 성균관의대 소아과 삼성제일병원 진단방사선과 민 지 연.](https://reader035.fdocuments.net/reader035/viewer/2022070407/56649e4c5503460f94b41938/html5/thumbnails/15.jpg)
Abnormal Doppler pattern (absence or reversal during atrial contraction); 90% of cases with chromosomal anomalies
NT & Ductus Venosus
Normal Absent A Reversed A
![Page 16: First and Early Second Trimester Diagnosis of Fetal Heart Disease 성균관의대 소아과 삼성제일병원 진단방사선과 민 지 연.](https://reader035.fdocuments.net/reader035/viewer/2022070407/56649e4c5503460f94b41938/html5/thumbnails/16.jpg)
NT & Ductus Venosus
Abnormal DV flow in euploid fetuses with increased NT helps to identify those with underlying CHD
142 euploid fetuses with increased NT
Major CHD in 7/11 with abnormal flow
No CHD in 131 fetuses with normal flow
![Page 17: First and Early Second Trimester Diagnosis of Fetal Heart Disease 성균관의대 소아과 삼성제일병원 진단방사선과 민 지 연.](https://reader035.fdocuments.net/reader035/viewer/2022070407/56649e4c5503460f94b41938/html5/thumbnails/17.jpg)
NT, Other Possible Mechanism
Venous congestion in head and neck
Failure of lymphatic drainage if impaired fetal movement
Abnormal or delayed development of lymphatic system
Altered composition of subcutaneous connective tissue
![Page 18: First and Early Second Trimester Diagnosis of Fetal Heart Disease 성균관의대 소아과 삼성제일병원 진단방사선과 민 지 연.](https://reader035.fdocuments.net/reader035/viewer/2022070407/56649e4c5503460f94b41938/html5/thumbnails/18.jpg)
Embryonic & Fetal Heart Rate
Suspicion of CHD; cardiac decompensation Spontaneous abortion
![Page 19: First and Early Second Trimester Diagnosis of Fetal Heart Disease 성균관의대 소아과 삼성제일병원 진단방사선과 민 지 연.](https://reader035.fdocuments.net/reader035/viewer/2022070407/56649e4c5503460f94b41938/html5/thumbnails/19.jpg)
Precautions & Recommendations
Difficulties in pathological confirmation More complex, more severe
hemodynamic disturbance, frequent spontaneous miscarriage
Considerable experience 13–15 weeks’ gestation High-risk patients
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