2-Fetal Echo part 2 Dr Ahmed Esawy

Dr. Ahmed Esawy
MBBS M.Sc
MD
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Fetal Echocardiography
Part 2
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Fetal Echocardiography
Dr/AHMED ESAWY

FETAL CARDIOLOGY VALVULAR
LESION
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Dr/AHMED ESAWY
Valvular and Obstructive lesions
Coarctation of aorta
Vascular rings
Aortic stenosis.
AI, MS, hypopalstic heart.
Cotriatrium
Fallot (F5,F4, F3.)
Pulmonary. Atresia
Ebestien anomaly

Lesion that may be associated with
normal four chamber view
• Transposition of great vessels
• Tetralogy of fallot
• Double outlet right ventricle
• Pulmonary atresia with a VSD
• Common arterial trunk
• Absent pulmonary valve syndrome
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TGV may be missed on four chamber
view
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TOF may be missed on four chamber
view
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AORTIC STENOSIS
• A. Valvular stenosis (2/3):
• B. Sub-valvular stenosis (1/3):
• C. Supra-valvular stenosis rare
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AORTIC STENOSIS
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Aortic stenosis
Aortic stenosis: hypertrophic left ventricle, thickened aortic valve, slightly enlarged
aortic root with high velocity turbulent flow and mitral regurgitationDr/AHMED ESAWY

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Heart anomalies detectable on the five-
chamber view during systole
Turbulent flow across the stenotic aortic valve

• Aortic stenosis. Doppler through aortic valve
reveals increased systolic velocity (arrow),
with maximal velocity of 218 cm/s, indicative
of severe aortic stenosis. LV = left ventricle.Dr/AHMED ESAWY

Aortic stenosis with turbulent flow (green pixels), as seen in the five-chamber Continuous wave
Doppler allows a quantification of stenosis.
Dr/AHMED ESAWY

INTERRUPTED AORTIC ARCH
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• aortic valve stenosis and bilateral supenor venae cavae. Three-vessel
view on sonography shows that ascending aorta (A) is enlarged
because of poststenotic dilatation.
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Aortic atresia and MV hypoplasia
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Hypoplastic Lt. heart
syndrome

Coarctation of Aorta
• <1% CHD
• Cong. stenosis just distal to Lt. subclavian a.
• Recurrence risk = 2% (1 sib), 6% (2 sibs)
• When ductus closes, tissue at insertion on
proximal desc aorta constricts (post ductal
coarctation)
• 6th arch forms ductus arteriosus; 4th arch forms
transverse aorta
Dr/AHMED ESAWY

• Narrowing just distal to take off of left
subclavian artery
• Hypoplasia of 4th arch
• Visualization of arch is insensitive
• Large RV and PA relative to LV and
Aorta
Dr/AHMED ESAWY

• Flow across TV / MV > 2 / 1
(normal < 1.8 / 1)
• Assoc w/ other cardiac defects =
bicuspid aortic valve, VSD, ASD…
• 10% association with chromosomal
anomalies (especially Turner’s)
Dr/AHMED ESAWY

COARCTATION AND TUBULAR
HYPOPLASIA OF THE AORTA
Dr/AHMED ESAWY

Coarctation/tubular hypoplasia of aortic arch
:Coarctation/tubular hypoplasia
of aortic arch: ventricular
disproportion with dominance of
the right cavities, small aortic
arch compared to the ductal arch
in the transverse view, small and
tortuous aortic with the
impression of a shelf in the
longitudinal views
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TRICUSPID VALVE
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Tricusped atresia Lt axis deviation
• An ASD is vital (Rt. Lt. shunt leading to central
cyanosis .
• 3 variations are known= keith classificatin
• Tricuspid atresia with intact vent. Septum
• Atresia with large VSD + Or - pulm. Atresia
• Atresia with large VSD + transposition of great
vessles
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Tricuspid dysplasia with extreme
cardiomegally
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Ebstein malformation of the tricuspid valve
Ebstein malformation of the tricuspid valve: the leaflets of the tricuspid valve are
displaced apically compared to the atrioventricular junction and there is massive
tricuspid regurgitation
Dr/AHMED ESAWY

Tricuspid dysplasia
Cardiomegaly, enlargement of the right side of the heart and right atrium in particular,
massive regurgitation across a normally inserted tricuspid valveDr/AHMED ESAWY

Severe valvular insufficiency with
retrgrade flow give mosaic patteren
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Atrioventricular valve
insufficiency during
systole. (a) Trivial tricuspid
regurgitation (TR) from the
right ventricle into the right
atrium (RA). (b) TR in
pulmonary atresia, which
showed holosystolic high
velocities on spectral
Doppler. (c) Severe TR with
cardiomegaly
in tricuspid dysplasia and
pulmonary atresia. (d)
Bilateral regurgitation in a
fetus with atrioventricular
septal defect. (e) Bilateral
regurgitation in a fetus with
cytomegalovirus infection
and myocarditis. (f) Bilateral
regurgitation in the
recipient in twin–twin-
transfusion
syndrome (RA, LA, right and
left atrium; RV, LV, right and
left ventricle).

Same fetus with doppler M mode shows
daistolic and systolic perfusion of the valve
indicating holosystolic tricuspid insufficiency
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DD of
tricuspid
insufficiency
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Daigram of
tricuspid atresia
with VSD
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Tricuspid valve dysplasia
Tricuspid valve dysplasia with severe tricuspid insufficiency and cardiomegaly. Retrograde flow
from the right ventricle (RV) to the right atrium (RA) is seen in blue and turbulence is coded by
green pixels
Dr/AHMED ESAWY

TA+VSD
color doppler demonstrate flow from
LA to LV and VSD to RV
Dr/AHMED ESAWY

3D/4D fetal echocardiography
• A 4-dimensional
(4D) ultrasound
(US) rendered
reconstruction of a
tricuspid
regurgitation jet
(arrow) is shown.
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Tricuspid valve insertion is lower in the
right ventricle with TI
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• Tricuspid atresia (*) and ventricular septal defect (VSD). Arrows show
the direction of flow; due to the atresia of the tricuspid valve,
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Tricuspid atresia
• the right ventricle is hypoplastic or absent and
color Doppler demonstrates the absence or
minimum flow from the right atrium to the right
ventricle.
Dr/AHMED ESAWY

Tricuspid dysplasia and Ebstein anomaly
The characteristic finding is that of a massively enlarged right atrium, a small right ventricle,
and a small pulmonary artery. Doppler can be used to demonstrate regurgitation in the right
atrium
Dr/AHMED ESAWY

• Severe tricuspid regurgitation. Pulsed wave Doppler (left) is not useful due
to the aliasing phenomenon and the maximal velocities that can be
assessed are 180 cm/s (arrow). The continuous wave transducer allows
assessment of very high velocities; in this case 420 cm/s
Dr/AHMED ESAWY

• Regurgitation of the tricuspid valve. On the left, trivial
regurgitation and, on the right, valve regurgitation in a
fetus with an atrioventricular septal defect.
Dr/AHMED ESAWY

Ebstein Anomaly
Dr/AHMED ESAWY

Ebstein's anomely TI+PS+ASD ( Rt.axis
deviation )
• Shift of Rt. atrio-vent. septum:
• 1. Atrialization of Rt. vent. (part of RA is formed by
vent. wall).
• 2. Tricuspid valve arising distal to annulus T.I.
• 3. Well developed Rt. outflow tract (only
contracting part on Rt. side).
• 4. Occasional ASD (Rt. Lt. shunt).
Dr/AHMED ESAWY

Ebstein Anomaly
• <1% CHD
• Recurrence risk = 1% (1 sib), 3% (2
sibs)
• Apical displacement of TV; small RV;
RA grossly dilated because TV
incompetent
Dr/AHMED ESAWY

Ebstein Anomaly
• Assoc with ASD, WPW syndrome
(30%), RV outflow obstruction (PS);
CHF in utero from TR
• Surgery to replace TV ; arrhythmia is
frequent after correction (dilated RA)
Dr/AHMED ESAWY

Ebstein Anomaly
4 Chamber View
TV
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• Ebstein's defect. A large right atrium is seen (arrow).
Dr/AHMED ESAWY

• Ebstein anomaly. Four-chamber view shows
• apical displacement of tricuspid valve (arrow) from level of annulus
(arrowhead) with severe dilation of right atrium (RA), consistent with
Ebstein anomaly.
• A and B indicate measurement of right atrium,Dr/AHMED ESAWY

• Ebstein's Anomaly : very thickened and apically displaced tricuspid
valve, severe cardiomegaly, severely dilated right atrium
Dr/AHMED ESAWY

• Ebstein’s anomaly of tricuspid valve Three-vessel view on
sonography shows that main pulmonary artery (P) is smaller
than ascending aorta (A). a = descending aorta, d = ductus
arteriosus, It = left, rt right, S = spine, v = superior vena cava
Dr/AHMED ESAWY

double aortic arch in fetus
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fetal right aortic arch
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References
1. Diagnostic Ultrasound of Fetal Anomalies: Text and Atlas,
Nyberg DA, Mahony BS, Pretorius DH, 1990, Year Bood
Medical Publisher, Inc.
2. Sonography of the Normal Fetal Heart: A Practical Approach,
Frates MC, AJR 1999; 173: 1363-70.
3. Prenatal Diagnosis of Congenital Cardiac Anomalies: A
Practical Approach Using Two Basic Views, Barboza JM,
Dajani NK, Glenn LG, Angtuaco Tl, Radiographics 2002; 22:
1125-1138.
4. Structural Fetal Abnormalities: The Total Picture, Rodger C
Sanders et al, 2nd edition, 2002 Mosby, Inc.
Dr/AHMED ESAWY

References
5. Fetal Echocardiography: An Atlas, Kathryn L Reed, Caroline F
anderson, Lewis Shender, 1988 Alan R Liss, Inc, NY, NY.
6. Color Atlas of Fetal Cardiology, Lindsey Allan, Gurleen
Sharland, Andrew Cook, 1994 Mosby – Wolfe Publishing.
7. Significance of Fetal Intracardiac Echogenic Foci in Relation
to Trisomy 21: A prospective Sonographic Study of High –
Risk Pregnant Women, Manning JE, Ragavendra N, Sayre J,
Laifer-Narin SL, Melany ML, Grant EG, Crandall BF, AJR 1998;
170: 1083-4.
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FETAL CARDIOLOGY
VALVULAR LESION
PULMONARY VALVE,TOF
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PULMONARY VALVE
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PULMONARY STENOSIS
types:
• 1-Valvular
• 2-Infandibular.
• 3- Supra valvular
• 4- Peripheral rare.
Pulm. stenosis may be isolated or associated with other CHD
• F4 and F3
• Common ventricle
• Tricuspid atresia (Rt. vent. inflow obst.)
• Transposition of great vessels
Dr/AHMED ESAWY

Relationship of three vessels (ascending aorta [A], main
pulmonary artery [P], superior vena cava [VI) in tetralogy
of Fallot. a = descending aorta, It = left, rt = right
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RT hypoplasia with pulmonary hypoplasia
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Isolated pulmonary atresia
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Isolated PS
flow 3.5M/S
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• Pulmonary stenosis.
• maximal velocity of 240 cm/s,
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Pulmonic stenosis
:Pulmonic stenosis: severe hypertrophy of right
ventricle with little anterograde flow and
regurgitation across the tricuspid valve;
thickened and poorly opening pulmonary valve;
streaming of flow into the pulmonary artery
due to the combination of anterograde high
velocity flow across the stenotic pulmonic valve
and retrograde flow from the ductus venosus
Dr/AHMED ESAWY

Pulmonary atresia with intact ventricular septum
Pulmonary atresia with intact ventricular septum: the right ventricle is small, there is
significant tricuspid regurgitation, there is no flow across the pulmonary vale, and
there is streaming of flow into the pulmonary artery as a consequence of retrograde
perfusion through the ductus arteriosusDr/AHMED ESAWY

• Pulmonary stenosis. A three-vessel view (A) shows
pulmonary artery stenosis (arrow); there is a
prominent aorta (Ao) since the patient also had a VSD.
The color Doppler image (B) shows high peak velocities
with aliasing. PA – pulmonary artery.
Dr/AHMED ESAWY

PULMONARY STENOSIS AND
PULMONARY ATRESIA
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Pulmonary atresia with intact VS
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Tetralogy of Fallot
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COMPONENT
• Pulm. stenosis (valvular (20%)and or
infandibular(50%).
• 2. Rt. vent. hypertrophy.( no failure due to
overieded aorta)
• 3. Large VSD (membranous) infracristal (1/2-1 cm)
.equalize the pr. In both ventricles
• 4. Over-riding aorta (post displacement of inter-
vent. septum as part of RVH).+
Dr/AHMED ESAWY

Tetralogy of Fallot
• VSD, infundibular pulmonic stenosis,
over-riding aorta, RV hypertrophy
• 5-10% of CHD
• Frequently not visualized on four
chamber view (aside from VSD)
Dr/AHMED ESAWY

Tetralogy of Fallot
• Associated with chromosome
anomalies (12-50%)
• Recurrence risk = 2.5% (1 sib), 8% (2
sibs)
• Cause = unequal division of the conus
into smaller RV portion and larger LV
portion
Dr/AHMED ESAWY

Tetralogy of Fallot
Caliber of aorta > PADr/AHMED ESAWY

TOF
• The aorta (arrow) is seen
overriding the interventricular
septum (S) on this LV outflow view
(A), with turbulence (arrowhead)
Dr/AHMED ESAWY

Tetralogy of Fallot.
Outflow tract view
shows aorta (AO)
overriding
ventricular septal
defect (arrows).
Dr/AHMED ESAWY

Tetralogy of Fallot
• Four-chamber view is generally normal(only
31% of cardiac malformations are associated
with an abnormal four chamber view),
Dr/AHMED ESAWY

TOF
• “Five-chamber
view overriding
of the aorta
and the
ventricular
septal defect
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TOF Enlarged aortic root
Dr/AHMED ESAWY

Tetralogy of Fallot
Tetralogy of Fallot: a large aorta overrides the ventricular septum, the pulmonary
artery patent but significantly reduced in size and the right outflow tract is restricted
Dr/AHMED ESAWY

• Tetralogy of Fallot
• overriding aorta (arrows) that originates from both left
and right
Dr/AHMED ESAWY

TETRALOGY OF FALLOT
Dr/AHMED ESAWY

• Five-chamber view in a fetus with tetralogy of Fallot
(TOF)
• overriding aorta (Y-shape).
Dr/AHMED ESAWY

TRANSPOSITION
OF
GREAT VESSELS
TGV
Dr/AHMED ESAWY

Dr/AHMED ESAWY
Cardiac Anomalies with Usually Normal Four-Chamber View
Transposition of the Great Arteries
Tetralogy of Fallot
Pulmonary Atresia with Ventricular Septal Defect
Double Outlet Right Ventricle
Truncus Arteriosus Communis
Mild Ebstein's Anomaly
Small Ventricular Septal Defect
Small Atrial Septal Defect
Mild/Moderate Aortic Stenosis
Mild/Moderate Pulmonary Stenosis
Mild/Moderate Coarctation of the Aorta
Partial Anomalous Pulmonary Venous Drainage

• Transposition of the great vessels (TGV) is a
group of congenital heart defects involving an
abnormal spatial arrangement of any of the
great vessels: superior and/or inferior venae
cava, pulmonary artery, pulmonary veins, and
aorta.
• Congenital heart diseases involving only the
primary arteries (pulmonary artery and aorta)
belong to a sub-group called transposition of
the great arteries.
Dr/AHMED ESAWY

• I. Complete transposition:
• a. 1st. possibility : Ao from RV, PA from LV.
• b. 2nd. possibility: both atria are inverted so it's corrected
• c. 3rd. possibility : ventricles are also inverted: PA from RV -
Ao from LV
• 2. Inverted transposition: (aorta to the Lt. and ant. to PA>)
• 1st possibility: syst. V. RA RV PA lungs PV LA
LV Ao (corrected)
• 2nd possibility (atria are inverted)
• 3 rd possibility (inverted vent).
Dr/AHMED ESAWY

• The most common form of TGA is Dextro-TGA (D-
TGA), in which the right ventricle is to the right of the
left ventricle and the aorta anterior to and to the
right of the pulmonary artery.
Dr/AHMED ESAWY

• Levo-Transposition of the Great Arteries (L-TGA), occasionally referred to as “congenitally
corrected-TGA,” describes an anatomical abnormality in which the morphological left ventricle is
on the right side of the heart. Deoxygenated systemic blood enters the right atrium, goes through
the morphologic left ventricle, and enters the pulmonary circulation via the pulmonary artery.
Oxygenated blood from the pulmonary circulation then enters the left atrium, goes through the
morphologic right ventricle and enters systemic circulation via the aorta.
Dr/AHMED ESAWY

Transposition of the Great Vessels
• 4-6% of CHD
• Recurrence risk = 1.5% (1 sib), 5% (2 sibs)
• Association with excessive vitamin A
• Rarely associated with chromosome
abnormalities
Dr/AHMED ESAWY

Transposition Great Vessels
• VSD (30-50%)
• Aorta arises anterior and to the right
of PA; great vessels parallel each
other
• 5 year survival (surgery) 90%
Dr/AHMED ESAWY

Relationship of three vessels (ascending aorta [A], main pulmonary
artery [P1, superior vena cava [VI) in complete transposition of great
arteries. a = descending
aorta, d = ductus arteriosus, It = left, rt = right.Dr/AHMED ESAWY

Relationship of three vessels (ascending aorta [Al, main pulmonary
artery [P1, superior vena cava [VI) in corrected transposition of great
arteries. a = descending aorta, LV = left ventricle, RV = right ventricle, It
= left, rt = right.
Dr/AHMED ESAWY

• D-transposition of great arteries. Outflow view shows
aorta (AO) and pulmonary artery (PA) parallel to each
other, with AO originating from right ventricle (RV) and
PA from left ventricle (LV).Dr/AHMED ESAWY

Complete transposition of the great arteries
• .
(a) four chamber view
with parallel outflow
tracts from the base
of the heart
(b) left ventricule with the
pulmonary aretery .the left heart
view demonstrating that the
vessel connected to the left
ventricle has a posterior course
and bifurcates into the two
pulmonary arteries
: (c) the vessel connected
to the right ventricle has
a long upward course and
gives rise to the brachio-
cephalic vessels
Dr/AHMED ESAWY

• Transposition of the great arteries demonstrating the
abnormal connection of the right ventricle (RV) with the
aorta (AO) and the left ventricle (LV) with the pulmonary
trunk (TP). Both great arteries show a parallel course.
Dr/AHMED ESAWY

TGV
• (A) shows the two
outflow tracts parallel to
each other (OF1, OF2).
The color Doppler image
• (B) shows that the flow
in both outflow tracts is
in the same direction.
Ao – aorta, PS –
pulmonary artery.
Dr/AHMED ESAWY

TRANSPOSITION OF THE GREAT
ARTERIES
Dr/AHMED ESAWY

Typical appearance of transposed great
arteries is shown echocardiographically and
diagrammatically in fetus at 23 weeks’
gestation
Dr/AHMED ESAWY

• Transverse sonogram of outflow tract view
shows parallel great vessels. Note aorta arises
from right ventricle and pulmonary artery
arises from left ventricle.Dr/AHMED ESAWY

Transposition of Great Vessels
• D-type (“complete”) = heart
tube loops to the right…
normal orientation of
ventricles; but vessels
malform (cyanosis)
• L-type (“congenitally
corrected”) = heart tube
loops to the left…
ventricular inversion, but
normal vessel orientation
(no cyanosis)
Dr/AHMED ESAWY

• Two-dimensional ultrasonographic images of TGA. A, Normal 4-
chamber view of the fetal heart. B, Visualization of the outflow tracts.
The great arteries leave the ventricles in parallel: the pulmonary artery
is connected to the left ventricle, and the aorta is connected to the right
ventricle. Ao indicates aorta; LA, left atrium; LV, left ventricle; PA,
pulmonary artery; RA, right atrium; and RV,
• right ventricle.
Dr/AHMED ESAWY

Dr/AHMED ESAWY
d-Transposition of the great
arteries with discordant connections
of the great vessels

• Fetus of 20 weeks’ gestation with persistence of left superior vena
cava and absence of right superior vena cava. Three-vessel view on
sonography shows that superior vena cava (v) is seen on left side
of small pulmonary artery (P). Arrow indicates tip of left atrial
appendage. A = ascending aorta, a = descending aorta, It = left,rt
= right, S = spine. Dr/AHMED ESAWY

• Fetus of 2Oweeks’ gestation with bilateral superior venae
cavae. Three-vessel view on sonography shows four vessels.
Normal right superior vena cava (v) is small Additional vessel,
persistent left superior vena cava (v*), is seen at left posterior
aspect of main pulmonary artery (P). A = ascending aorta, a =
descending aorta, It = left, rt = right, S = spine.Dr/AHMED ESAWY

DUBLE OUTLET
RIGHT VENTRICLE
DORV
Dr/AHMED ESAWY

• 1% of CHD
• Recurrence risks not defined
• Both PA and at least half of the aorta
originate from RV
• Karyotype abnormalities = 5%;
including Trisomy 13,18
Dr/AHMED ESAWY

• Associated with VSD, ascending
aortic stenosis, pulmonic stenosis, AV
abnormalities
• Complex embryologic changes
involving bulbus cordis (RV), conus
cordis (septum), and truncus
arteriosus (great vessels)
Dr/AHMED ESAWY

Left Ventricular Outflow Tract
• Identify: LV, RV, IV septum, aorta (normal caliber), +/- LA, +/- RA
• Medial wall of the ascending aorta merges with the top of the IV
septum (most frequent location for VSD)
• Pathology: VSD, tetralogy of Fallot, transposition, truncus arteriosus
Dr/AHMED ESAWY

Right Ventricular Outflow Tract
• Identify: branching of the main PA into right PA and
ductus arteriosus (to desc Aorta), asc aorta in cross
section, desc aorta to left of spine; verify PA crosses
anterior to asc aorta
• Pathology: transposition, truncus arteriosusDr/AHMED ESAWY

• Double-outlet right ventricle in a fetus with a breech presentation. (a)
Transabdominal US image (four-chamber view) shows a normal appearance
of the ventricles. Arrow spine, Dao descending aorta. (b) Transabdominal
US image (base view) shows that the ascending aorta (Aao) and
pulmonary artery (PA) are parallel and both arise from the right ventricle.
Dr/AHMED ESAWY

• Double outlet
right ventricle.
Right
ventricularv
outlet view
shows aorta (AO)
and pulmonary
artery (PA)
originating from
right ventricle
(RV). LV = left
ventricle.
Dr/AHMED ESAWY

Double outlet right ventricle
• : Double outlet right ventricle (DORV) with both the aorta (AO) and
pulmonary trunk (TP) arising from the right ventricle. Color Doppler
demonstrates blood flow from the right ventricle into both vessels and the
flow is not turbulent because there is no stenosis.
Dr/AHMED ESAWY

• Double-outlet right ventricle. Both outflow tracts
(OF1 and OF2) are seen arising from the right
ventricle (RV).
Dr/AHMED ESAWY

DOUBLE OUTLET RIGHT VENTRICLE
Dr/AHMED ESAWY

Typical appearance of double outlet right ventricle
Dr/AHMED ESAWY

Dr/AHMED ESAWY
Double-outlet right ventricle
with both vessels arising from
the right ventricle. RV, LV, right
and left ventricle.

• Double-outlet right ventricle .
Dr/AHMED ESAWY

• double-outlet right ventricle. Three-vessel view on sonography shows
that ascending aorta (A) and main pulmonary artery (ascend have
side-by-side relationship. It = left, rt = right, S = spine, v = superior
vena cava ) Dr/AHMED ESAWY

Both the PA and aorta (more than 50%) arise from the RV
Dr/AHMED ESAWY

HYPOPLASTIC HEART
Dr/AHMED ESAWY

Hypoplastic Lt. heart syndrome
• Commonest cause of neonatal cardiac failure.
• A. Atresia of Ao. arch, Ao. valve and mitral
valve, Rudementary lt ventricle:
• There's associated ASD, PDA.
• PDA is essential for the baby to live.
Dr/AHMED ESAWY

Hypoplastic Left Heart
• 2-4% of CHD
• Hypoplasia of the LV; MV / AV stenosis or
atresia
• Assoc with coarctation of aorta (80%)
when AV atretic
• Hypothesis: low blood flow to LV causes
hypoplasia
Dr/AHMED ESAWY

• Causes hypoperfusion of coronary
arts; CHF from ischemia
• Cyanosis at birth if LA to RA shunt
not adequate
• Associated with chromosomal
anomalies = 16% (one half from
Trisomy 18 alone)
Dr/AHMED ESAWY

Hypoplastic Right Heart
• Underdevelopment of right sided heart
structures
• Hypoplasia of the RV and PA; RV wall
thick; hypoplastic or incompetent TV; PV
atresia
• Relies on patent ductus arteriosus for
blood supply to lungs (PGE1)
• Tx = surgical sytemic to pulmonary shunt
(Blalock Taussig Shunt)
Dr/AHMED ESAWY

• Hypoplastic left heart syndrome
• left ventricle is small relative to the right ventricle
and the left atrium is small relative to the right
atrium. Arrow spine.
Dr/AHMED ESAWY

Hypoplastic left heart syndrome
:Hypoplastic left heart syndrome: there is a small left ventricle with an internal
echogenic lining suggestive of endocardial fibroelastosis, there is no flow across the
mitral valve and the aortic arch is perfused in a retrograde mannerDr/AHMED ESAWY

Dr/AHMED ESAWY

• Hypoplastic left heart syndrome..
Dr/AHMED ESAWY

• Hypoplastic aorta.
• A, Axial image shows normal size
of pulmonary artery (arrow) with
severe hypoplasia of aorta
(arrowhead). DA = ductus
arteriosus, RV = right ventricle.
• B, Another axial image shows
severe hypoplasia of aorta
(arrowhead). In addition, there is
ventricular septal defect (arrows)
that allows flow from left ventricle
(LV) to RV.
Dr/AHMED ESAWY

Hypoplastic left heart syndrome -
Dr/AHMED ESAWY

• Hypoplastic left heart syndrome, this fetus shows a hypoplastic hypokinetic left
ventricle. This is due to the combination of aortic atresia and patent but dysplastic
mitral valve. Color Doppler shows one-sided perfusion across right ventricular
inflow tract.
Dr/AHMED ESAWY

some forms of critical aortic stenosis or hypoplastic left heart syndrome with diminutive left
ventricle (a),
or in hypoplastic right ventricle in some forms of pulmonary atresia (c) (RA, LA, right and left
atrium; RV, LV, right and left ventricle; V,
ventricle; VSD, ventricular septal defect).
Dr/AHMED ESAWY

Dr/AHMED ESAWY
Heart anomalies with one color stripe in diastole in the four-chamber view
Unilateral perfusion from the right atrium into the right ventricle in hypoplastic (a) or absent
left ventricle (b).

• Hypoplastic left heart. USG image (A) shows an echogenic left
ventricle (arrow). Doppler images (B,C) show absent flow on the left
side (arrow in B), and reversal of flow in the aortic arch (arrow in C)
Dr/AHMED ESAWY

•Hypoplastic left heart
•Single atrium
•Large VSD
Dr/AHMED ESAWY

Hypolastic heart syndrome
may be diagnosed of five screening views
Dr/AHMED ESAWY

HYPOPLASTIC LEFT HEART SYNDROME
Dr/AHMED ESAWY

4 Chamber ViewDr/AHMED ESAWY

The left ventricle (LV) is absent (?) due to mitral
atresia and aortic atresia.
Dr/AHMED ESAWY

• hypoplastic right
heart syndrome.
• B, thickened leaflets
of tricuspid valve
(arrows), with
restricted opening,
consistent with
tricuspid stenosis
Dr/AHMED ESAWY

Hypoplastic right ventricle (arrow)
Dr/AHMED ESAWY

Small RV, thick wallDr/AHMED ESAWY

Small RV
Notice the
moderator band
Dr/AHMED ESAWY

Right ventricular hypoplasia
•Antenatal RVHS
•Neonatal RVHS
Dr/AHMED ESAWY

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