ultrasound diagnosis of fatal anomalies

TRANSPOSITION OT THE GREAT ARTERIES
Ventricular tachycardia: normal atrial rhythm
with an increased frequency in the heart chamber.
Mostly benign.
Clinical management: Further sonographic
screening, including fetal echocardiography. Intermittent
ultrasound monitoring. M-mode
echocardiography. Depending on the form and
cause of the tachyarrhythmia, initially therapy
with transplacental medication (e.g., digoxin
and flecainide, possibly sotalol). If this therapy is
not successful, or in case of fetal hydrops, direct
administration of agents into the umbilical vein
(e.g., amiodarone is favorable due to its long halflife;
side effects include hypothyroidism in the
fetus). This treatment option should only be
used in units with experience in prenatal cardiology.
In a mature fetus, delivery and postnatal
therapy is an option. Vaginal delivery is possible.
Procedure after birth: After birth, facilities for
intensive medical treatment are required. In
severe cases that do not respond to this, electrophysiological
diagnosis and intervention with
ablation of extra conduction points or other
structures determining the cardiac rhythm using
a catheter can be an option as the last resort.
Prognosis: Fetal hydrops develops within 48 h in
case of fetal tachycardia of 220–240 bpm. The
mortality is very high in these cases. The tachycardias
are usually well treatable using medications.
Transposition of the Great Arteries (TGA)
Definition: In D-TGA, the aorta arises from the
right ventricle and lies ventral and to the right
(D, dextro-)of the pulmonary artery. The pulmonary
artery arises posteriorly from the left ventricle.
In L-TGA (corrected transposition; L,
levo-), the atrioventricular and ventriculoarterial
connections are discordant, so that the
hemodynamic situation is corrected.
Incidence: One in 2000 births, 5% of all congenital
heart disease.
Clinical history/genetics: Recurrence rate in case
of one affected sibling is 1.5%, in case of two affected
siblings 5%.
References
Chang CL, Chao AS, Wu CD, Lien R, Cheng PJ. Ultrasound
recognition and treatment of fetal supraventricular
tachycardia with hydrops: a case report. Chang Keng
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Fyfe DA, Meyer KB, Case CL. Sonographic assessment of
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Gembruch U, Bald R, Hansmann M. Color-coded M-
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Gembruch U, Hansmann M, Bald R, Redel BA. Supraventricular
tachycardia of the fetus in the 3rd
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extrasystole. Geburtshilfe Frauenheilkd
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Teratogens: High doses of vitamin A, amphetamines,
trimethadione, sexual steroids.
Associated malformations: Situs inversus.
Ultrasound findings: The two great vessels run
parallel to each other instead of crossing. The
aorta arises from the right ventricle and runs
ventral to the pulmonary trunk, which arises
from the left ventricle. The aorta is identified because
of its arch and the branches arising from it.
The pulmonary trunk is recognized due to its bifurcation
into the right and left pulmonary arteries.
The isthmus of the aorta may show stenosis.
In 40% of cases, a concomitant VSD and
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