Diagnostic ultrasound ( PDFDrive )

CHAPTER 37 The Fetal Heart 1295
P
LV
LA
RA
S
RV
SP
RV
LA
P
RA
LV
A
B
FIG. 37.41 Cardiomyopathy. (A) Concentric hypertrophy of the ventricular heart walls (P) and the interventricular septum (S) in fetus with
hypertrophic cardiomyopathy. (B) All four cardiac chambers are enlarged, occupying more than half the fetal chest in this fetus with dilated
cardiomyopathy. A pleural effusion is also seen. LA, Left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; SP, spine.
LA
FIG. 37.42 Endocardial Fibroelastosis. Subcostal four-chamber
view shows echogenic walls of the left ventricle (LV). LA, Left atrium;
RA, right atrium; RV, right ventricle.
have associated anomalies. 154 he prognosis for fetal cardiomyopathy
is variable, depending on the severity of the cardiac lesion,
the underlying cause, and associated anomalies. When hydrops
accompanies cardiomyopathy, the prognosis is poor.
Ectopia Cordis
Ectopia cordis is a rare malformation in which the heart is located
outside the thoracic cavity. It results from failure of fusion of
the lateral body fold in the thoracic region. Ectopia cordis is
classiied by the following four types 221 :
RA
LV
RV
1. horacic (60%). he heart is displaced from the thoracic
cavity through a sternal defect.
2. Abdominal (30%). he heart is displaced into the abdomen
through a diaphragmatic defect.
3. horacoabdominal (7%). he heart is displaced from the
chest through a defect in the lower sternum, with an associated
diaphragmatic or ventral abdominal wall defect (pentalogy
of Cantrell).
4. Cervical (3%). he heart is displaced into the neck area.
Although most cases are isolated, ectopia cordis may be
associated with pentalogy of Cantrell, a condition characterized
by a sternal clet, ventral diaphragmatic hernia, omphalocele,
intracardiac anomalies, and ectopia cordis. 222 A variety of cardiac
and chromosomal anomalies are associated with ectopia cordis.
he sonographic diagnosis is generally not diicult and has been
made as early as 9 weeks’ gestation, 223 although the abdominal
and cervical types have not been reported in utero (Fig. 37.43).
he prognosis is poor, with most infants dying within a few days
of birth. 224
ARRHYTHMIAS
Premature Atrial and
Ventricular Contractions
Premature atrial contractions (PACs) and premature ventricular
contractions (PVCs) are abnormal atrial or ventricular contractions
originating from locations other than the sinus node. PACs
account for almost 75% and PVCs for 8% of fetal arrhythmias. 40,225
PACs are associated with redundancy of the foraminal lap (atrial
septal aneurysm), maternal cafeine ingestion, and smoking. 226,227
In 1% to 2% of PACs, a structural cardiac anomaly is present. 37
PACs may be conducted or nonconducted. In either case,
the atrial pacemaker is “reset” so that the next normal atrial