o_1977r8vv9vk1ts2ms0kd8pksa.pdf

452 R. Chaoui et al.
Fig. 31.2. Apical four-chamber view in color in a 30-week
fetus demonstrates both inferior left and right pulmonary
veins (LPV, RPV) entering the left atrium (red). Flow toward
the transducer is visualized in red. On the left side the superior
left pulmonary vein is seen in blue. (LA, RA left and
right atrium, LV, RV left and right ventricle)
Fig. 31.3. Basal visualization of the heart in a dorsoanterior
fetal position. Both inferior and superior right pulmonary
veins (RPVi, RPVs) are seen in blue entering the left atrium
(LA). Note the color presetting as seen on the color bar
with +18 cm/s
Fig. 31.4. Left approach to the fourchamber
view with one left pulmonary
vein seen in real-time image (in harmonic
mode). The flow is parallel to the insonation
angle and this plane is ideal
for visualizing pulmonary flow, here
seen in blue. LA left atrium
31.4). When using color Doppler, velocity range
should be reduced to a range of 15±25 cm/s (Figs.
31.3, 31.7) with low filter and high persistence as we
have described elsewhere [1]. The visualization of
pulmonary veins using color Doppler is possible from
the late first trimester by optimizing color Doppler
presets (Fig. 31.8). Whether this contributes to increased
diagnosis accuracy is not yet known. We include
this visualization in first trimester mainly in
cases with suspected isomerism or in targeted examination,
e.g., when totally anomalous pulmonary venous
connection (TAPVC) was present in a previous
child.
Usually it is sufficient to identify one pulmonary
vein on each side during a routine study [2]. If, however,
there is a heart defect detected, it is advisable to
demonstrate at least three of the veins [2]. The examiner
has, however, to be careful when assuming that