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Chapter 33 Doppler Echocardiography for Managing Congenital Cardiac Disease Dev Maulik Introduction Fetal cardiac development is regulated by various genetic and environmental influences. Aberrations in these developmental mechanisms result in structural and functional abnormalities of the fetal heart. There has been a greater recognition of the need for antepartum diagnosis of these disorders in recent years. Perinatal diagnosis and management of congenital cardiac disease in conjunction with advances in pediatric cardiac surgery has led to remarkable improvements in the outcome in these infants. An essential component of this approach is the reliable prenatal diagnosis, which permits planning and implementation of appropriate perinatal management. Although high-resolution two-dimensional (2D) dynamic imaging remains the foundation of fetal echocardiographic assessment, the Doppler modality constitutes an essential component of this process by providing hemodynamic insight into the morphologic and functional aberrations of the fetal heart. With the advent of real-time three-dimensional (3D) echocardiography, there are exciting possibilities for prenatal cardiac assessment including Doppler echocardiography. In the previous chapter, we reviewed the scope and technique of Doppler echocardiography and normative information on fetal cardiac hemodynamics, while the next chapter, which is a new addition to this edition, deals with real-time 3D echocardiography of the human fetus. In this chapter, we review the risk factors for congenital cardiac disease, the common indications for fetal cardiac evaluation, and the application of Doppler echocardiography in managing malformations and dysrhythmias of the fetal heart. Risk Factors and Indications for Fetal Cardiac Evaluation Congenital cardiac disease, as diagnosed clinically, has a prevalence of approximately 8 cases per 1,000 live births [1]. The rate of critical cardiac malformations requiring early therapeutic and surgical intervention has been reported to be 3.5 per 1,000 live births [2]. The risk of cardiac malformations is increased in many conditions (Table 33.1). When these risk factors are present, prenatal counseling and diag- Table 33.1. Risk factors for congenital heart disease Familial History of congenital cardiac disease Genetic syndromes (Mendelian) Noonan Tuberosus sclerosis Marfan Holt-Oran TAR (thrombocytopenia with absent radii) Maternal Congenital heart disease Teratogenic exposure Anticonvulsants ± phenytoin, trimethadione, valproic acid Lithium Amphetamines Retinoic acid Alcohol Nonteratogenic exposure Indomethacin Maternal infection Viral ± rubella, cytomegalovirus, coxsackievirus, mumps Parasitic ± toxoplasmosis Metabolic disease Diabetes mellitus Phenylketonuria Autoimmune disease Obstetrical Polyhydramnios Fetal Suspicion of cardiac malformation in basic fetal scan Abnormal fetal cardiac rhythm Extracardiac malformation Increased nuchal translucency Chromosomal disorders Down's syndrome Trisomy 13, 18 Turner's syndrome Genetic syndromes Fetal growth restriction Nonimmune hydrops Situs inversus and ambiguous
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Editor Associate Editor for Gynecol
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Editor Dev Maulik, MD, Ph.D. Winthr
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Preface It is with great pleasure w
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Contents 1 Doppler Sonography: A Br
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a Contents XIII Heart and Great Ves
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a Contents XV 15 Pulsed Doppler Ult
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a Contents XVII 22 Doppler Velocime
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a Contents XIX Clinical Application
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a Contents XXI Terbutaline ........
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XXIV Authors Torvid Kiserud, MD, Ph
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2 D. Maulik Fig. 1.2. Title page of
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4 D. Maulik Fig. 1.4. Model of the
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6 D. Maulik Table 1.1. Feasibility
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Chapter 2 Physical Principles of Do
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a Chapter 2 Physical Principles of
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20 D. Maulik one-fourth of a cycle
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22 D. Maulik arterial [6] hemodynam
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24 D. Maulik nomena. The autoregres
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26 D. Maulik far field the beam pro
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28 D. Maulik Mirror Imaging With th
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30 D. Maulik hand, compromise Doppl
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32 D. Maulik vent of broad bandwidt
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34 D. Maulik: Chapter 3 Spectral Do
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36 D. Maulik frequency; the image i
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38 D. Maulik flow directionality du
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40 D. Maulik Doppler Velocity Measu
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42 D. Maulik and for the B-mode ima
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44 D. Maulik known as the Fourier P
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46 D. Maulik Fig. 4.17. Total varia
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48 D. Maulik inverted, but not the
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50 D. Maulik of a ventricular pump,
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52 D. Maulik Table 4.3. Hemodynamic
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54 D. Maulik Placental Vascular Cha
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56 D. Maulik: Chapter 4 Spectral Do
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58 T. Kiserud Fig. 5.2. The impact
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60 T. Kiserud Fig. 5.7. The pressur
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62 T. Kiserud Fig. 5.10. Doppler re
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64 T. Kiserud Fig. 5.13. Upper pane
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66 T. Kiserud of umbilical flow in
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Chapter 6 Sonographic Color Flow Ma
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a Chapter 6 Sonographic Color Flow
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Chapter 7 Three-dimensional Color a
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a Chapter 7 Three-dimensional Color
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Chapter 8 Biological Safety of Diag
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a Chapter 8 Biological Safety of Di
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Although the question of inertial o
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114 J. Itskovitz-Eldor, I. Thaler w
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116 J. Itskovitz-Eldor, I. Thaler d
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118 J. Itskovitz-Eldor, I. Thaler F
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120 J. Itskovitz-Eldor, I. Thaler T
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122 J. Itskovitz-Eldor, I. Thaler t
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128 J. Itskovitz-Eldor, I. Thaler 7
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130 J. Itskovitz-Eldor, I. Thaler 8
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Chapter 10 Umbilical Doppler Veloci
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a Chapter 10 Umbilical Doppler Velo
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146 K. MarsÏ—l Fig. 11.2. Record
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148 K. MarsÏ—l total end-diastol
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150 K. MarsÏ—l Table 11.1. Refer
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152 K. MarsÏ—l Fig. 11.11. Absen
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154 K. MarsÏ—l Diabetes Mellitus
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156 K. MarsÏ—l Table 11.5. Follo
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158 K. MarsÏ—l umbilicalis und d
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Chapter 12 Intrauterine Blood Flow
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a Chapter 12 Intrauterine Blood Flo
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l a Chapter 12 Intrauterine Blood F
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178 P. Arbeille et al. Fig. 13.1. I
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180 P. Arbeille et al. Fig. 13.3. I
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182 P. Arbeille et al. Fig. 13.5. a
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184 P. Arbeille et al. Fig. 13.10.
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186 P. Arbeille et al. Cerebral±Um
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188 P. Arbeille et al. moglobin con
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190 P. Arbeille et al. These result
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192 P. Arbeille et al. Fig. 13.15.
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194 P. Arbeille et al. cause IUGR i
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196 P. Arbeille et al. circulation
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Chapter 14 Cerebral Blood Flow Velo
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a Chapter 14 Cerebral Blood Flow Ve
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212 J. C. Veille Doppler Principles
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214 J. C. Veille Fig. 15.5 a±c. No
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216 J. C. Veille Table 15.2. Resist
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218 J. C. Veille response to hypoxi
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220 J. C. Veille Fetal Renal Artery
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222 J. C. Veille cardiac output in
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224 J. C. Veille 28. Silver LE, Des
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Chapter 16 Doppler Velocimetry of t
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a Chapter 16 Doppler Velocimetry of
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Chapter 17 Doppler Velocimetry of t
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data support the view that prostagl
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282 W. J. Ott Table 18.1. Fetal wei
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284 W. J. Ott Fig. 18.4. Umbilical
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286 W. J. Ott diastolic notching in
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288 W. J. Ott Fig. 18.8. Normal (hi
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290 W. J. Ott Fig. 18.10. Normal in
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292 W. J. Ott Fig. 18.14. Non-react
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294 W. J. Ott 21. Tamura RK, Sabbag
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296 W. J. Ott 93. Divon MY (1995) R
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298 W. J. Ott: Chapter 18 Doppler U
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300 H. Odendaal Fig. 19.1. Differen
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302 H. Odendaal Time to Establish t
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304 H. Odendaal were most frequentl
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306 H. Odendaal In addition to lowe
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308 H. Odendaal complications by co
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310 H. Odendaal cal artery: a sign
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Chapter 20 Doppler Velocimetry and
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a Chapter 20 Doppler Velocimetry an
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criterion of a hemoglobin differenc
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Chapter 21 Doppler Sonography in Pr
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a Chapter 21 Doppler Sonography in
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340 A. Lysikiewicz [11]. Hypoprotei
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342 A. Lysikiewicz The splenic arte
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344 A. Lysikiewicz Fig. 22.5. Fetal
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346 A. Lysikiewicz Scalp edema and
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348 A. Lysikiewicz selection of the
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350 A. Lysikiewicz References 1. Da
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Chapter 23 Doppler Velocimetry in P
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a Chapter 23 Doppler Velocimetry in
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Redistribution of fetal cardiac out
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Chapter 24 Doppler Velocimetry for
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a Chapter 24 Doppler Velocimetry fo
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Although comparisons have been made
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Chapter 25 Absent End-Diastolic Vel
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a Chapter 25 Absent End-Diastolic V
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The homeostatic significance of abs
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Chapter 26 Doppler Velocimetry for
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striction or hypertensive disease o
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404 Y. Chiba et al. apex at ventric
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406 Y. Chiba et al. Fig. 27.5. An e
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408 Y. Chiba et al. Fig. 27.12. Bip
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410 Y. Chiba et al. Fig. 27.16. Blo
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Chapter 28 Ductus Venosus Torvid Ki
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a Chapter 28 Ductus Venosus 415 low
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a Chapter 28 Ductus Venosus 417 Fig
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a Chapter 28 Ductus Venosus 419 Fig
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a Chapter 28 Ductus Venosus 421 mor
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a Chapter 28 Ductus Venosus 423 sli
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a Chapter 28 Ductus Venosus 425 men
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a Chapter 28 Ductus Venosus 427 119
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430 A.A. Baschat coronary vessels a
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432 A.A. Baschat Fig. 29.2. The ori
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434 A.A. Baschat Fig. 29.6. The fet
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436 A.A. Baschat Clinical Applicati
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438 A.A. Baschat agement [67±69].
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440 A.A. Baschat 20. Spahr R, Probs
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Chapter 30 Doppler Interrogation of
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a Chapter 30 Doppler Interrogation
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452 R. Chaoui et al. Fig. 31.2. Api
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454 R. Chaoui et al. Fig. 31.7. Spe
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456 R. Chaoui et al. supported by a
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510 D. Maulik true real-time 4D ech
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512 D. Maulik Fig. 34.6. Two-dimens
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514 D. Maulik Fig. 34.11. Four-dime
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516 D. Maulik: Chapter 34 Four-Dime
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518 W. J. Ott Fig. 35.2. The oxygen
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520 W. J. Ott Table 35.1. Causes of
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522 W. J. Ott Velocity Measurements
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524 W. J. Ott Fig. 35.9. Doppler bl
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526 W. J. Ott 5. The presence of va
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528 W. J. Ott Fig. 35.10. Regressio
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530 W. J. Ott Fig. 35.11. The signi
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532 W. J. Ott walls in fetuses of d
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534 W. J. Ott 39. Sharf M, Abinader
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536 W. J. Ott: Chapter 35 Doppler E
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538 D. Arduini, G. Rizzo General Pr
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540 D. Arduini, G. Rizzo tween the
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542 D. Arduini, G. Rizzo Fig. 36.2.
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544 D. Arduini, G. Rizzo the condit
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546 D. Arduini, G. Rizzo: Chapter 3
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548 J. C. Huhta et al. The equipmen
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550 J. C. Huhta et al. presence of
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552 J. C. Huhta et al. say of the i
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554 J. C. Huhta et al. amination. I
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556 J. C. Huhta et al.: Chapter 37
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558 I. Zalud, L. D. Platt Fig. 38.1
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562 I. Zalud, L. D. Platt were non-
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564 I. Zalud, L. D. Platt two benig
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568 I. Zalud, L. D. Platt: Chapter
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570 I. Zalud and pulsed-wave Dopple
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572 I. Zalud Fig. 39.4. Corpus lute
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574 I. Zalud Table 39.2. Data on wo
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576 I. Zalud corpus luteum, respect
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578 I. Zalud Previous studies have
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580 I. Zalud cavity is ªcoldº wit
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582 I. Zalud Fig. 39.20. Ipsilatera
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584 I. Zalud However, recent advanc
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586 I. Zalud [60]. If a 50-mg dose
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588 I. Zalud ous increase in the RI
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590 I. Zalud production of progeste
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592 I. Zalud Fig. 39.33. Pulsed-wav
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594 I. Zalud Fig. 39.37. Luteal blo
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596 I. Zalud cal aspects and diagno
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Chapter 40 Doppler Ultrasonography
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a Chapter 40 Doppler Ultrasonograph
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612 Subject Index anomalous ± A-V
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614 Subject Index ± ± cerebral va
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616 Subject Index ± ± absence of
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618 Subject Index ± cerebral Doppl
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620 Subject Index ± therapy 553 in
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622 Subject Index ± systolic/diast
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624 Subject Index postextrasystolic
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626 Subject Index serum estradiol c
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628 Subject Index trisomy 525 troph
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630 Subject Index visceral ± malro
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