(精选)ROLE OF FETAL ECHOCARDIOGRAPHY IN CONGENITAL HEART DISEASES教学课件.pptVIP

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(精选)ROLE OF FETAL ECHOCARDIOGRAPHY IN CONGENITAL HEART DISEASES教学课件.ppt

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ROLE OF FETAL ECHOCARDIOGRAPHY IN CONGENITAL HEART DISEASES BY JAMEEL A. AL-ATA CONSULTANT AND ASSISTANT PROFESSOR OF PEDIATRIC CARDIOLOGY INTRODUCTION Incidence of CHD is 6-8/1000 live births and about 1.5% in the fetus population. Nearly all types of postnatally diagnosed CHD types were diagnosed prenatally. The more complex in utero CHD the more diagnosed and the simpler can be missed in utero (ASD, mild AS, mild PS). Some CHD types are shown to evolve and progress in utero e.g Valvar AS. 17-48% of in utero CHD is associated with chromosomal abnormalities (only 5-10% postnatally) and 20% with extracardiac malformations. INTRODUCTION, CON’T; Fetal Echocardiography is an accurate diagnostic tool for CHD (85-90% sensitivity; 99% specificity) when using state of the art U/S technology and when pediatric cardiology/fetal medicine collaborates. Routine obstetrical U/S is not a good screening test for CHD. It is both late (20-24 wks) and not comprehensive. Indications include: DM, INFESTIONS, TERATOGENS ABN 4 CH VIEW, HX OF CHILD WITH CHD, CHROMOSOMAL ABN, EXT CARDIAC ABN, DEXTROCARDIA, SITUS INVERSUS, FETAL GROWTH RETARDATION AND FETAL ARRHYTHMIA. Fig. 5: Apical four chamber view of the fetal heart (LV, left ventricle; RV, right ventricle; LA, left atrium; RA, right atrium; MB moderator band; PV, pulmonary veins; Ao, descending aorta; S, fetal spine) ON EPIDEMIOLOGY Malformations due to pregnancy termination True incidence of CHD is 1.0% (0.2-0.4% higher than detected postnatally). Up to 48% of in utero CHD is associated with chromosomal anomalies and 20% with extracardiac malformations. Possible decreased prevalence of subsets of CHD associated with severe extracardiac malformations. continue In a recent study one hundred and forty-nine fetuses with CHD and normal karyotype were analyzed. Seventy-six fetuses had conotruncal anomalies. 22q11.2 deletion was present in 10 cases (6.7%), all of which had conotruncal anomalies (13.1%). continue Thymic hypoplasia