Fetal Cardiology Simplified: A Practical Manual

390 Pages·2013·13.86 MB·English

by  Gurleen Sharland

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Fetal cardiology has developed into an exciting new subspecialty over the last 30
years. Most health professionals involved in examining the fetal heart are not ‘experts’
F Fetal Cardiology
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in fetal cardiology and may find interpreting images difficult, particularly in cases with a
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a cardiac abnormality. This book is designed as a practical guide, to be kept near the a
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ultrasound machine, for all those performing fetal heart scans without the expertise of io
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a fetal cardiologist. The aim of the book is to provide a logical and clear approach to
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scanning the normal heart and how to easily recognise the common forms of fetal IM
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cardiac anomalies. The book also provides information on the associated lesions and IF
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outcomes from fetal life.
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The book has a large number of clearly labelled illustrations to allow the reader to A
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recognise the different types of cardiac problem they may encounter and the various IC
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forms in which they can manifest.
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This book reflects over 20 years of personal experience as a specialist fetal
cardiologist, which has included teaching a range of healthcare professionals on how
to look at the fetal heart in a structured way. It is aimed at all sonographers, fetal
medicine specialists, obstetricians, cardiac technicians/physiologists and radiologists
performing obstetric ultrasound scans, as well as paediatric cardiologists with an
interest in fetal cardiology.
ISBN 978-1-903378-55-7
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Gurleen Sharland
9 781903 378557
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Fetal Cardiology
S I M P L I F I E D
A PRACTICAL MANUAL
Gurleen Sharland
i
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Fetal Cardiology Simplified – A Practical Manual
tfm Publishing Limited, Castle Hill Barns, Harley, Nr Shrewsbury, SY5 6LX, UK
Tel: [phone]; Fax: [phone]
E-mail: [email protected];
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First Edition: © 2013
Paperback ISBN: 978-1-903378-55-7
E-book editions: 2013
ePub ISBN: 978-1-908986-93-1
Mobi ISBN: 978-1-908986-94-8
Web pdf ISBN: 978-1-908986-95-5
The entire contents of Fetal Cardiology Simplified – A Practical Manualis copyright tfm
Publishing Ltd. Apart from any fair dealing for the purposes of research or private study,
or criticism or review, as permitted under the Copyright, Designs and Patents Act
1988, this publication may not be reproduced, stored in a retrieval system or
transmitted in any form or by any means, electronic, digital, mechanical, photocopying,
recording or otherwise, without the prior written permission of the publisher.
Neither the author nor the publisher can accept responsibility for any injury or
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or use of any product described herein. Neither can they accept any responsibility
for errors, omissions or misrepresentations, howsoever caused.
The author and publisher gratefully acknowledge the permission granted to
reproduce the copyright material where applicable in this book. Every effort has been
made to trace copyright holders and to obtain their permission for the use of
copyright material. The publisher apologizes for any errors or omissions and would
be grateful if notified of any corrections that should be incorporated in future reprints
or editions of this book.
Printed by Gutenberg Press Ltd.,
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Tel: [phone]; Fax: [phone]
ii
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Contents
page
v
Foreword
vi
Acknowledgements
vii
Dedication
viii
Abbreviations
Screening for congenital heart disease 1
Chapter 1
The normal fetal heart 9
Chapter 2
Abnormalities of cardiac size, position and situs 55
Chapter 3
Abnormalities of the four-chamber view (I) 67
Chapter 4
Abnormalities of veno-atrial and atrioventricular connection
Abnormalities of the four-chamber view (II) 109
Chapter 5
Abnormalities of atrioventricular valves and the ventricular septum
with normal connections
Abnormalities of the four-chamber view (III) 127
Chapter 6
Obstructive lesions at the ventriculo-arterial junction that may be
associated with an abnormal four-chamber view
Great artery abnormalities (I) 175
Chapter 7
Abnormalities of ventriculo-arterial connection
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Fetal Cardiology Simplified – A Practical Manual
Great artery abnormalities (II) 203
Chapter 8
Abnormalities of ventriculo-arterial connection
Aortic arch abnormalities 239
Chapter 9
Cardiomyopathies 261
Chapter 10
Cardiac tumours 275
Chapter 11
Other cardiac anomalies 283
Chapter 12
Rhythm disturbances in the fetus 303
Chapter 13
Counselling and outcome following prenatal diagnosis of 331
Chapter 14
congenital heart disease
What could cardiac findings mean? 339
Chapter 15
361
Further reading
375
Index
iv
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Foreword
This handbook is designed to be an aid to those involved in the detection, diagnosis and
management of fetal heart abnormalities. This will include obstetric sonographers,
obstetricians, fetal medicine specialists, cardiac technicians/physiologists and paediatric
cardiologists training in fetal cardiology, as well as paediatric cardiology consultants with less
experience of fetal cardiology. This book will also be useful as a teaching tool for anyone
involved in scanning the fetal heart.
It is assumed that the reader will be familiar with scanning the fetus and the fetal heart and
it is not the aim of this book to teach the practicalities of fetal cardiac scanning, as there are
many publications already available to help with this. The purpose of this book is to help
interpret cardiac findings and aid in making a correct cardiac diagnosis. The focus of this
book is on structural cardiac malformations, though a section on arrhythmias is also included.
It is envisaged that many of those using this manual will not have a background in paediatric
cardiology. For this reason, the abnormalities have been grouped depending on whether the
four-chamber view is likely to be abnormal or not. However, paediatric cardiologists will
examine the heart by initially examining the cardiac connections and then looking for further
associated abnormalities. This concept has been maintained, both in descriptions of the
normal heart and in discussions of abnormal heart anatomy.
Whilst some information is included regarding management and outcome, this is not a
textbook of paediatric cardiology and further information can be sought in larger textbooks or
publications and by consulting paediatric cardiology colleagues, who have wider in-depth
knowledge and experience in managing congenital heart disease. It is well recognised that
the outcome and associations documented from fetal life may differ from those reported in
postnatal series. Therefore the outcomes and associations noted in a large fetal series are
referred to here. This information is based on a single-centre experience of fetal cardiac
abnormalities seen between 1980 and 2010 at the Evelina Children’s Hospital, which is part
of Guy’s and St Thomas’ NHS Foundation Trust, in London, UK.
Gurleen Sharland BSc MD FRCP
Reader/Consultant in Fetal Cardiology
Fetal Cardiology Unit
Evelina Children’s Hospital
Guy’s & St Thomas’ NHS Foundation Trust
London, UK
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Acknowledgements
I would like to thank all my family and dear friends for endless encouragement and
support.
I would also like to thank and acknowledge my colleagues and all members of the fetal
cardiology team at Evelina Children’s Hospital, London. Their continuing dedication and
professionalism has enabled the development of a first class service providing high
standards of care for patients and their families.
vi
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Dedication
To
Mike, Peter and Emma
with all my love and much more
and
with love and thanks to my very dear parents,
Mani and Puran
vii
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Abbreviations
A atrial
Abs PV absent pulmonary valve syndrome
ALSCA aberrant left subclavian artery
Ao aorta
AoA aortic arch
AoAt VSD aortic atresia with a ventricular septal defect
AoV aortic valve
ARSCA aberrant right subclavian artery
AS aortic stenosis
Asc Ao ascending aorta
AVSD atrioventricular septal defect
AV valve atrioventricular valve
AVVR atrioventricular valve regurgitation
CAT common arterial trunk
CCAML congenital cystic adenomatoid malformation of the lung
CCTGA congenitally corrected transposition of the great arteries
CHB congenital heart block
CHD congenital heart disease
Coarct coarctation of the aorta
Coll a collateral vessel
CS coronary sinus
DAo descending aorta
Diabetic maternal diabetes
DIV double-inlet ventricle
DORV double-outlet right ventricle
Ebstein’s Ebstein’s anomaly
ECG electrocardiogram
Fabn fetal abnormality
Farr fetal arrhythmia
FH family history
Fhyd fetal hydrops
FO foramen ovale
HLH hypoplastic left heart syndrome
INFD death in infancy
Int AA interrupted aortic arch
IUD intrauterine death
IVC inferior vena cava
LA left atrium
LAI left atrial isomerism
LAVV left atrioventricular valve
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Abbreviations
LCA left coronary artery
LPA left pulmonary artery
LSVC left superior vena cava
LTFU lost to follow-up
LV left ventricle
LVDD left ventricular diastolic dimension
LVSD left ventricular systolic dimension
MAT mitral atresia
MPA main pulmonary artery
MR mitral regurgitation
MV mitral valve
NND death in neonatal period
NT nuchal translucency
PA pulmonary artery
PAPVD partial anomalous pulmonary venous connection
PAT IVS pulmonary atresia with an intact ventricular septum
PAT VSD pulmonary atresia with a ventricular septal defect
PE pericardial effusion
PV pulmonary valve
PS pulmonary stenosis
RA right atrium
RAI right atrial isomerism
RAVV right atrioventricular valve
RCA right coronary artery
RPA right pulmonary artery
RSVC right superior vena cava
RV right ventricle
SVC superior vena cava
SVT supraventricular tachycardia
T trachea
TAPVD total anomalous pulmonary venous connection or drainage
TAT tricuspid atresia
Tetralogy tetralogy of Fallot
TGA transposition of the great arteries
ToF tetralogy of Fallot
TOP termination of pregnancy
TR tricuspid regurgitation
TV tricuspid valve
TVD tricuspid valve dysplasia
UV umbilical vein
V ventricle or ventricular
VSD ventricular septal defect
ix