Andersons pediatric cardiology 214
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ModalitiesforImaging
Two-DimensionalImaging
Cross-sectionalimagingremainsthegoldstandardforthediagnosisofstructural
cardiacdiseaseduringfetallife.ThePediatricCounciloftheAmericanSociety
ofEchocardiographyrecommendsobtainingmultiplecross-sectional
tomographicviewsoftheheartinordertomakeanaccuratediagnosis.15Fetal
echocardiographyshouldincludeanapicalfour-chamberviewoftheheart,an
apicalfive-chamberview,along-axisviewoftheleftventricularoutflowtract,a
long-axisviewoftherightventricularoutflowtract,ashort-axisviewatthe
levelofthearterialtrunks,ashort-axisviewattheleveloftheventricles,alongaxisviewofthecavalveins,aviewoftheductalarch,andaviewoftheaortic
arch(Table8.1;Figs.8.1and8.2).15TheAmericanInstituteofUltrasoundin
Medicinealsorecommendsthethree-vesseltrachealview,31whichhasproven
usefulintheassessmentofcriticalcongenitalheartdisease32–35aswellasaortic
archanomalies.Thefetalheartrateshouldbedocumentedandanyarrhythmia
confirmedwithM-modeimaging.Thediametersoftheorificesofallvalves
shouldbemeasuredinsystoleatrightanglestotheplaneofflow.15Reference
rangesforthediametersofallvalvesoverthecourseofgestationhavebeen
published.36Cardiacdysfunctionmaybeassessedbycross-sectional
interrogationbythepresenceofascites,pleuralorpericardialeffusions,skin
edema,andcardiomegalyasdefinedbyaratioofcardiothoracicareasgreater
than0.36.37Aratioofcardiothoracicareasgreaterthan0.6isassociatedwithan
extremelypooroutcome.38
Table8.1
EssentialComponentsoftheFetalEchocardiogram
Feature
Anatomicoverview
Biometricexamination
Cardiacimagingviews/sweeps
EssentialComponent
Fetalnumberandpositionintheuterus
Establishstomachpositionandarrangementofabdominalorgans
Establishcardiacposition
Cardiothoracicratio
Biparietaldiameter
Femorallength
Four-chamberview
Four-chamberviewangledtowardgreatarteries(five-chamberview)
Dopplerexamination
Measurements
Examinationofrhythmandrate
Long-axisview(leftventricularoutflow)
Long-axisview(rightventricularoutflow)
Short-axissweep,cephaladanglingtoincludethethree-vesselview
Long-axisviewofcavalveins
Ductalarchview
Aorticarchview
Inferiorandsuperiorcavalveins
Pulmonaryveins
Hepaticveins
Venousduct
Ovalforamen
Atrioventricularvalves
Arterialvalves
Arterialduct
Transverseaorticarch
Umbilicalartery
Umbilicalvein
Atrioventricularvalvardiameter
Arterialvalvardiameter
Pulmonarytrunk
Ascendingaorta
Rightandleftpulmonaryarteries
Transverseaorticarch
Ventricularlength
Ventricularshort-axisdimensions
M-modeofatrialandventricularmuralmotion
Dopplerexaminationofpatternsofatrialandventricularflow
FIG.8.1 Tomographicplanesusedtoimagethefetalcardiovascular
system.Imagingplanesdisplayedareinanormalhumanfetus.Startingat
thetopleft,thefollowingviewsaredemonstratedinaclockwisemanner:1,
apical(four-chamber)view;2,apical(five-chamber)viewangledtowardthe
aorta;3,long-axisviewoftheleftventricularoutflowtract;4,long-axisview
oftherightventricularoutflowtract;5,short-axisviewatthelevelofthe
greatvessels;6,short-axisviewwithcaudadanglingatthelevelofthe
