ultrasound diagnosis of fatal anomalies

THE HEART
Fig. 5.25 Hypoplastic left heart syndrome,
15 weeks, four-chamber view (apical), transvaginal
sonography. The right ventricle (rV) appears large in
comparison with the left ventricle (lV), which is
barelyvisible.
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5
seen for the first time as late as in the third trimester.
Clinical management: Further sonographic
screening. Karyotyping, consultation with pediatric
cardiologist. Vaginal delivery is possible.
Procedure after birth: As this anomaly is associated
with and dependent on the Botallo’s
duct, oxygen administration should not exceed
40–60%. Therapy with prostaglandin should
start immediately after birth.
Prognoses: This is a fatal condition without surgical
intervention. Cardiac surgical procedures
such as the Norwood operation (at least three
surgical corrections)are performed, with survival
rates of 20–70%. Heart transplantation has
also been tried in these children recently; the
success rate has been reported to be as high as
70%. In the long run, the quality of life after these
interventions remains limited. After the Norwood
operation, persistent neurological deficits
have been described in up to 70% of the infants.
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