Pitfalls in Fetal Echocardiography Jung Yun Choi
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Transcript of Pitfalls in Fetal Echocardiography Jung Yun Choi
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Pitfalls in Fetal Echocardiography
Jung Yun Choi
Department of Pediatrics
Seoul National Univ. Children’s Hospital
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Pitfalls of Fetal Echocardiography
• Pitfalls due to technical factors
• Pitfalls related to interpretation
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Pitfalls due to technical factors
Structural Image
Doppler Spectral Image
Color Doppler image
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Pitfalls in Structural Image
Echo drop-out
Artifact : Shadowing
Imperfect resolution
Slice thickness
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Echo drop-out; Shodowing; Artifact
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Pitfalls in Color Doppler image
Low frame rate
Poor range resolution
Poor velocity resolution
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Range resolution Velocity resolution
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Resolution of color Doppler study
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Velocity Scale Change
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Transducer Frequency Change
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Pitfalls in assessing size
Normal size
Large heart
Small heart
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Normal size
• What is normal ? Mean ± 2 SD
• Growth parameters : gestational period,
body weight, head circumference, height, etc
• Heart parameters : dimension, area, volume
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Large Heart
• Right or left or both sides
• Causes – cardiac malformation– valvular or ventricular dysfunction– secondary to fetal diseases
• Effects on fetus; long-term effects
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Small Heart
• Anatomic definition: diameter / area below - 2 SD ?
• Functional definition : too small to be a ventricle
• Growth parameters : body weight > gestational age
• Any potential of catch up growth ?
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How small?
• Too small: hardly seen, no potential of growth
• Questionable
• Not too small: -2 ~ -3 SD, may have a potential
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Too Small Heart
• Causes : HLHS, HRHS
• How to assess : PFO, ductus, coronary fistula
• Counsel : single ventricle and Fontan
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Not Too Small
• Causes: unknown, COA, AS, MS, PS etc
• How to assess: complete study on heart / vessel
• Counsel : cautious optimism
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An example of LV being ‘Not Too Small’
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An example of LV being ‘Not Too Small’
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Pitfall in Natural History
• Newly diagnosed in the 3rd trimester
• Cardiac malformations become worse
• Cardiac defects / diseases become better
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Newly diagnosed in the 3rd trimester
• Cardiac malformation
• Cardiomyopathy
• Cardiac tumor
• Secondary cardiac disease
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Natural History
May get worse
May get better
May stay the same
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Pitfalls in Arrhythmia
• Technical pitfalls: difficult to obtain signal
• Interpretation: requires thorough knowledge
• Common mistake– transient bradycardia– intermittent premature contraction
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M-mode is difficult to obtain
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FrequentlyPoor Tracing: difficult to identify wall motion
← Ventricular wall
← Mitral valve
← Atrial wall
Occasionally
Good Tracing : Atrial wall contraction precedes mitral valve closure and ventricular contraction← Ventricular wall← Mitral valve← Atrial wall
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Premature Atrial Contraction
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Brief bradycardia is common
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Intermittent premature contraction is frequent