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a Chapter 33 Doppler Echocardiography for Managing Congenital Cardiac Disease 505
Fig. 33.28. Doppler identification of tricuspid regurgitation
in a fetus with complete heart block and heart failuee. Left:
The Doppler sample volume (oblique arrow) was placed in
the right atrium (RA) imaged in the aortic (AO) short axis
plane. Right: Doppler tracing shows prominent reversed
flow (R) during systole indicative of tricuspid incompe
tence. Normal flow patterns were seen during diastole (D).
M-mode echocardiogram (oblique arrow) was used to time
the diastolic and systolic phases of the fetal cardiac cycle.
Horizontal arrow denotes the position of the Doppler sample
volume for the M-mode system. B Doppler baseline, TV
tricuspid valve. (Reprinted from [12] with permission)
Summary
Recent years have witnessed significant progress in
the technique of fetal echocardiography and perinatal
management of fetal cardiac disease. Although 2D
cardiac imaging remains the major tool for this evaluation,
its diagnostic efficacy is significantly enhanced
by the other ultrasound modalities. Specifically,
spectral pulsed Doppler, 2D Doppler color flow
mapping, and color M-mode provide essential tools
for elucidating hemodynamic abnormalities associated
with structural and functional congenital cardiac
disease. This hemodynamic information plays a
crucial role in enhancing the efficacy of investigating
these complex problems. It is not surprising, therefore,
that Doppler echocardiography now plays such
a critical role in the diagnosis, treatment, and surveillance
of fetal cardiac disorders. Future developments
in this area will certainly encompass 3D Doppler flow
evaluation, which has been addressed in Chaps. 7
and 34.
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