2. FETAL MEDICINE CONSULTANT AT……
S L Raheja-Fortis Sanket Sonography,
Hospital, Mahim Borivali
BSES MG Hospital, Irla Nursing Home,
Andheri Vile Parle
Nowrosjee Wadia Belle Vue, Andheri
Hospital, Parel
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3. Trained at King’s College, London
Publications in national and international
indexed journals
Founder secretary Palghar Ob Gy Society
FOGSI accredited sonography training centre
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7. A part of routine mid trimester scan
Any one who is doing it should be doing it should
ATLEAST do a basic screening
Preferably extended screening
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9. Easy to standardize
Can be easily included in mid trimester scan protocol
without incurring additional expense/ time/ personnel
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24. CHDS NOT ASSOCIATED WITH
ABNORMAL 4 CH VIEW
1. Abnormalities of great vessels not associated with
any defect on cardiac chambers
2. CHDs with progressive evolution
3. CHDs not detectable in utero
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25. (1) ABNORMALITIES OF GREAT VESSELS
NOT ASSOCIATED WITH EFFECT ON
CHAMBERS
Mild Aortic stenosis,
Tetralogy of Fallot Coarctation of aorta ,
Pulmonary stenosis
Transposition of
great vessels Double outlet
ventricle
Truncus Arteriosus
Pulmonary atresia
with VSD
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32. LVOT-LEFT VENTRICULAR OUTFLOW
TRACT
Originates entirely
from LV
Septo Aortic
continuity
Free movement of the
valves
No post valvular
dilatation
No regurgitation on
colour doppler
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34. RVOT-RIGHT VENTRICULAR OUTFLOW
TRACT
Originates entirely
from RV
It is anterior and to
the left of aorta
Free movement of
valves
Bifurcates in two after
the origin
Aorta is seen as a ring
No regurgitation on
Doppler
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54. “4 CHAMBER VIEW + 3V VIEW +
3VT VIEW IN 2ND TRIMESTER
SCAN”
J of Perinatal Medicine
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55. A busy ANC clinic
Obstetrician did all mid trimester scans
Additional cardiac screening was easily achievable
No significantly extra time required
Very effective
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59. “PRENATAL DIAGNOSIS OF CONGENITAL
HEART DISEASE IN A NON-SELECTED
POPULATION
M. Juan et al
Fundacio Hospital Son Llatzer, Spain
“Ultrasound in Obstetrics and Gynaecology
2006;28;512-614
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60. 6953 fetuses underwent midtrimester scan
Yagel’s 5 transverse plane technique was used
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61. Neonatal Echocardiography or Autopsy was used to
confirm the diagnosis
The test had a sensitivity of 92.98% with positive
predictive value of 100%
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62. Screening Test DR
Risk Factors approach 11%
4 Chamber View 40%
5 plane Technique 92%
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64. Not a comprehensive echocardiography
Detailed echocardiography remains the best means to
pick up CHDs
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65. But we improve our pick up rate from 4% (cursory look
at heart ) to 60% (4 ch view) to 90% (4 ch + 3 VT view)
(Li H et al, China Medical University, Shanghai)
Integrate with malformation scan
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67. ISUOG guidelines suggest that the fetal cardiac
examination be performed between 18-22 weeks
Under exceptional conditions, it can be performed
earlier, especially if First Trimester Screening
shows an abnormality or increased Nuchal
Translucency
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69. High frequency probe to be used
Harmonic imaging may aid in better image
quality
Gray scale is the basis for examination
Narrow image field, high frame rate
Image should be zoomed till it occupies 1/3 to 1/ 2
of the display screen
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71. INDICATIONS FOR FETAL ECHO
When the risk for the fetus is more than
background rate of 0.8%
Maternal indications
Fetal indications
Increased NT
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73. WHEN SHOULD A FETAL ECHO BE DONE
Between 18-22 weeks
In case NT is increased then should be done at 14
weeks and then repeated
If First Trimester Screening shows some
abnormality then repeat at 14 weeks
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75. WHAT INFORMATION SHOULD
ECHOCARDIOGRAPHY PROVIDE?
Morphology of the heart
Size of chambers
Comparison of right and left sides
Relationship of outflow tracts
IVS
AV & Semilunar valves
Arches of Aorta
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77. WHAT INFORMATION SHOULD
ECHOCARDIOGRAPHY PROVIDE?
Function of heart
Myometrial contractility
Size
Endocardium
Flow across the connections
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