4D Fetal Echocardiography


by

Giuseppe Rizzo

DOI: 10.2174/97816080504441100101
eISBN: 978-1-60805-044-4, 2010
ISBN: 978-1-60805-634-7



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Congenital heart defects (CHD) are the most frequent malformation in the human fetus and are the leading cause of mortality due to mal...[view complete introduction]
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Table of Contents

Foreword

- Pp. i-ii (2)

Beryl R. Benacerraf

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Preface

- Pp. iii

Domenico Arduini and Giuseppe Rizzo

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Contributors

- Pp. iv-viii (5)

Domenico Arduini and Giuseppe Rizzo

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Epidemiology of Congenital Heart Diseases

- Pp. 1-7 (7)

Maurice Guirgis

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Second Trimester Screening of Congenital Heart Disease

- Pp. 8-19 (12)

Giovanna Ogge, Pietro Gaglioti, Manuela Oberto and Tullia Todros

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The Examination of the Normal Fetal Heart

- Pp. 20-28 (9)

Alessandra Toscano, Luciano Pasquini and Roberta Iacobelli

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Real Time Three Dimensional Fetal Echocardiography Using Two Dimensional Array Technology

- Pp. 29-37 (9)

Dev Maulik, David Mundy and Timothy Bennett

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Rendering Cardiac Volumes in Three and Four-Dimensional Ultrasonography

- Pp. 38-49 (12)

Jimmy Espinoza

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Analysis of Acquired Volumes: Methodological Approach

- Pp. 50-61 (12)

Greggory R DeVore

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The Applications of HD and B Flow in 4D Echocardiography

- Pp. 62-69 (8)

Simcha Yagel, Sarah M Cohen, Dan V Valsky, Michal Lipscheutz and Baruch Messing

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3D Live Echocardiography with Matrix Probes

- Pp. 70-77 (8)

Fabrizio Taddei, Laura Franceschetti, Giuliano Farina and Gianpaolo Grisolia

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Automated Echocardiography

- Pp. 78-84 (7)

Elena Sinkovskaya and Alfred Abuhamad

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Four D and 2D Echocardiographic Evaluation of Anomalies of the Venous Connections

- Pp. 85-94 (10)

Paolo Volpe, Valentina De Robertis, Campobasso Gianluca, Nicola Volpe and Georgios Rembouskos

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Three-Dimensional Ultrasound in Fetal Atrial, Ventricular and Atrioventricular Septal Defects

- Pp. 95-103 (9)

Rabih Chaoui

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4D Study of Right Heart Anomalies

- Pp. 104-118 (15)

Giuseppe Rizzo and Domenico Arduini

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4D Study of Left Heart Anomalies

- Pp. 119-134 (16)

Giuseppe Rizzo and Domenico Arduini

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Conotruncal Anomalies

- Pp. 135-146 (12)

Dario Paladini and Gabriella Sglavo

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First Trimester Study of Fetal Heart with 4D Echocardiography

- Pp. 147-159 (13)

Weissmann-Brenner Alina, Gindes Liat and Achiron Reuven

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Assessment of Cardiac Geometry and Stroke Volumes by 4D Fetal Echocardiography

- Pp. 160-177 (18)

Lami Yeo, Roberto Romero and Wesley Lee

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Feasibility, Technique and Potential Role of Fetal Cardiovascular MRI: Evaluation of Normal Anatomical Structures and Assessment of Congenital Heart Disease

- Pp. 178-196 (19)

Lucia Manganaro, Marco Di Maurizio and Sara Savelli

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Conclusions and Future Developments

- Pp. 197-200 (4)

Giuseppe Rizzo and Domenico Arduini

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Index

- Pp. 201-203 (3)

Giuseppe Rizzo and Domenico Arduini

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Foreword

When Drs. Rizzo and Arduini asked me to write this preface, I was honored and thrilled to have the opportunity to introduce this outstanding work!

Examining the fetal heart has always presented a huge challenge for ultrasound specialists. When I started in ultrasound 30 years ago, no one knew how to perform or even attempt the examination of the heart. Fetal echocardiography has progressed very rapidly, fueled by advances in image quality as well as increasing focus of the ultrasound community on the need for a proper examination of the heart. Even today, the detection of congenital heart defects remains at the very bottom of the list of identifiable abnormalities on a standard fetal sonogram, and well under 50% of congenital heart defects are identified prenatally. Detection of congenital heart disease has lagged behind the successful detection of other abnormalities of the fetus despite our best attempts to teach the necessary skills. The fetal heart is a difficult organ to evaluate due toits very small size, complex anatomy, dynamic blood flow physiology, as well as rapid rhythmical movement.

The importance of evaluating the heart cannot be over emphasized. Heart defects are among the most common malformations in the developing fetus and many of these anomalies are part of complex syndromes such as aneuploidies. Heart anomalies that occur as isolated defects are among the most challenging to detect, but are particularly important due to the need to prepare for a potentially sick newborn at delivery. I remember back in the early 80's when I first started in fetal ultrasound, the heart remained an enigma for many years and it was only after I missed several congenital heart defects in a row that I took on the enormous task of understanding the fetal heart and how it works. Unfortunately back then we did not have any books or educational aids such as Drs Rizzo and Arduini's wonderful e-book to guide us in learning how to evaluate the fetal heart.

I have been impressed for many years with the careers of Dr. Rizzo and Dr. Arduini who have made enormous contributions in the field of fetal imaging and in particular fetal echocardiography. They have both published extensively on this subject and are extremely well qualified to write and edit such a book. Drs. Rizzo and Arduini have made significant contributions in fetal echocardiography over many years and have been instrumental in developing many of the Doppler aspects of the fetal heart evaluation. They have assembled an impressive group of authors here, and have edited a first class book on 3-D and 4-D of the fetal heart. They have understood that 3-D and 4-D volume imaging are necessary to evaluate the fetal heart due to its inherent complexity of motion, flow and anatomy.

The book is very well organized in multiple short chapters that are beautifully illustrated both with ultrasound images and diagrams. Initially, they introduce the subject with a chapter on the epidemiology of fetal heart defects and why they are important. Next are the basic chapters on screening and on normal anatomy, which are key for the beginners as well as for more seasoned examiner. The following chapters introduce 3-D and 4D ultrasound, starting with technical aspects on how to obtain a good image. Many practitioners are intimidated by the complexity of obtaining 3-D and 4-D images. The chapters that introduce the technical aspects of 3-D such as image display and manipulation of the image are all superb introductions on how to produce the best image. The book then focuses on 3-D and 4-D evaluation of blood flow using Doppler, a key subject in the evaluation of the heart. Additional chapters cover new technologies, such as the use of the matrix probe and the automated screening possibilities for the fetal heart. This volume includes the often forgotten venous anatomy of the heart and its connections, an extraordinarily valuable chapter. The chapters on anomalies are divided into septal defects, right heart, left heart, and cono truncal abnormalities and each chapter combines 2-D, 3-D/4-D and Doppler in the demonstration of these malformations. The book also describes the state of the art for 1st trimester echocardiography, followed by quantitative aspects of the function of the fetal heart including stroke volume and cardiac output. The last chapter involves other forms of imaging of the fetal heart, such as MRI.

This book, while very comprehensive, remains simple in its approach. It makes a very complex and rather intimidating organ accessible to both the novice and the seasoned examiner. Furthermore, this book is presented as an Ebook which is a very innovative format, awaited with great anticipation. Such novel media will challenge the primacy of bulky printed books. Many books will soon be available as Ebooks and carried as a small discrete thumb-drive or even down loaded perhaps on an electronic device such as a Kindle. Electronic versions of books are the future of our industry and Drs. Rizzo and Arduini have stepped up to the plate in choosing such a modern and practical display for their book.

In conclusion, I am very excited about this Ebook, not only because of its superbly organized, well illustrated and presented content, but also because as an Ebook it can be carried and propagated throughout our community much more easily than a hard copy book would be. The authors have succeeded admirably in their endeavor to produce what promises to be a outstanding resource on the examination of the fetal heart.

Beryl R. Benacerraf M.D.
Clinical Professor of OB GYN and Radiology
Harvard Medical School
Boston Massachusetts


Preface

The examination of the fetal heart is part of the comprehensive fetal scan, but this examination is still considered a challenge even for experienced sonographers. Over the years, the number of ultrasound techniques used in fetal cardiology impressively increased and no other fetal organ is examined with as many modalities as the fetal heart including high resolution two dimensional (2D) imaging, M-mode examination, spectral, color, power, high-definition digital Doppler, B flow as well as tissue Doppler. It is, however, common knowledge that despite the availability of all these technologies, screening programs, especially when limited to the study of the "four chamber view", have shown disappointing low detection rates for congenital heart disease (CHD). Although the identification of CHD can be improved by routinely visualizing the outflow tracts, their diagnosis is greatly affected by the skill of the operator as well as his ability to interpret the findings.

Very recently, three- and four- dimensional (3D and 4D) technologies have been introduced in fetal cardiology and have revolutionized the way in which it is possible to study the heart. 4D ultrasonography may reduce the operator dependency of CHD diagnosis and adds the possibility to obtain offline virtual planes in cardiac examinations, views of the fetal heart difficult or impossible to obtain with conventional 2D ultrasound.

This new fetal cardiology ebook, we believe, will be of great value for all practicing clinicians wanting to start the study of the fetal heart with 4D ultrasonography. We have chosen a panel of contributors that are both leaders in this field and can represent the differences in practice between Europe and United States. This is a comprehensive guide intended for anyone interested in fetal heart scanning performing both routine screening ultrasonographic examinations and targeted heart scans. It aims to assist the reader with the following questions: how can I use this technology to acquire cardiac volumes?; how do I handle cardiac volume data sets after acquisition?; how can I improve diagnosis and definition of CHD? It is our hope that this book will provide a bridge between scientists using and testing new technologies for research purposes and clinicians wishing to improve their daily practice.

Giuseppe Rizzo
Domenico Arduini

List of Contributors

Editor(s):
Giuseppe Rizzo
University di Roma "Tor Vergata"
Italy




Co-Editor(s):
Domenico Arduini
Department of Obstetrics and Gynecology
Università di Roma Tor Vergata
Italy




Contributor(s):
Alfred Abuhamad M.D.
Department of Obstetrics and Gynecology
Eastern Virginia Medical School
Norfolk
VA
USA


Reuven Achiron M.D.
Department of Obstetrics and Gynecology
The Chaim Sheba Medical Center
Tel Hashomer, Affiliated with the Sackler Faculty of Medicine
Tel Aviv University
Tel Aviv
Israel


Domenico Arduini M.D.
Department of Obstetrics and Gynecology
Università Roma Tor Vergata
Rome
Italy


Timothy Bennett M.D.
Department of Obstetrics and Gynecology
University of Missouri-Kansas City School Medicine
Kansas City
MI
USA


Gianluca Campobasso M.D.
Fetal Medicine Unit
Di Venere and Sarcone Hospitals. ASL Bari
Bari
Italy


Rabih Chaoui M.D.
Prenatal Diagnosis and Human Genetics
Berlin
Germany


Sarah M. Cohen M.D.
Department of Obstetrics and Gynecology
Hadassah-Hebrew University Medical Centers – Mt. Scopus
Jerusalem
Israel


Valentina De Robertis
Fetal Medicine Unit
Di Venere and Sarcone Hospitals. ASL Bari
Bari
Italy


Greggory R. DeVore M.D.
Fetal Diagnostic Center
Pasadena
CA
USA


Marco Di Maurizio M.D.
Department of Radiology
Ospedale Meyer
Florence
Italy


Jimmy Espinoza M.D.
Department of Obstetrics and Gynecology
William Beaumont Hospital
Royal Oak
MI
USA


Giuliano Farina Ph.D.
Department of Obstetrics and Gynecology
Azienda Ospedaliera “C.Poma”
Mantova
Italy


Laura Franceschetti M.D.
Department of Obstetrics and Gynecology
Azienda Ospedaliera “C.Poma”
Mantova
Italy


Michal Lipscheutz M.D.
Department of Obstetrics and Gynecology
Hadassah-Hebrew University Medical Centers – Mt. Scopus
Jerusalem
Israel


Pietro Gaglioti M.D.
Department of Obstetrics and Gynecology
Maternal-Fetal Medicine Unit
University of Turin
Turin
Italy


Liat Gindes M.D.
Department of Obstetrics and Gynecology
The Chaim Sheba Medical Center Tel Hashomer
Affiliated with the Sackler Faculty of Medicine
Tel Aviv University
Tel Aviv
Israel


Gianpaolo Grisolia M.D.
Department of Obstetrics and Gynecology
Azienda Ospedaliera “C.Poma”
Mantova
Italy


Maurice Guirgis M.D.
University Paris VII
Service Explorations Fonctionnelles
Hôpital Robert Debré
Paris
France


Wesley Lee M.D.
Division of Fetal Imaging
William Beaumont Hopsital
Royal Oak
MI
USA


Lucia Manganaro M.D.
Department of Radiology
Università “La Sapienza”
Rome
Italy


Dev Maulik M.D., Ph.D.
Department of Obstetrics and Gynecology
University of Missouri-Kansas City School Medicine
Kansas City
Missouri
USA


Baruch Messing M.D.
Department of Obstetrics and Gynecology
Hadassah-Hebrew University Medical Centers – Mt. Scopus
Jerusalem
Israel


David Mundy M.D.
Department of Obstetrics and Gynecology
University of Missouri-Kansas City School Medicine
Kansas City
Missouri
USA


Roberta Iacobelli M.D.
Department of Pediatric Cardiology and Cardiac Surgery
Bambino Gesu’ Hospital
Rome
Italy


Manuela Oberto M.D.
Department of Obstetrics and Gynecology
Maternal-Fetal Medicine Unit
University of Turin
Turin
Italy


Giovanna Oggè M.D.
Department of Obstetrics and Gynecology
Maternal-Fetal Medicine Unit
University of Turin
Turin
Italy


Dario Paladini M.D.
Fetal Medicine & Cardiology Unit
Department of Obstetrics and Gynecology
University Federico II of Naples
Naples
Italy


Luciano Pasquini M.D.
Department of Pediatric Cardiology and Cardiac Surgery
Bambino Gesu’ Hospital
Rome
Italy


Georgios Rembouskos M.D.
Fetal Medicine Unit
Di Venere and Sarcone Hospitals. ASL Bari
Bari
Italy


Giuseppe Rizzo M.D.
Department of Obstetrics and Gynecology
Università Roma Tor Vergata
Rome
Italy


Roberto Romero M.D.
Department of Obstetrics and Gynecology
Wayne State University School of Medicine
Perinatology Research Branch Intramural Division
NICHD, NIH, DHHS Hutzel Women’s Hospital
Detroit
MI
USA


Sara Savelli M.D.
Department of Radiology
Università “La Sapienza”
Rome
Italy


Gabriella Sglavo M.D.
Fetal Medicine & Cardiology Unit
Department of Obstetrics and Gynecology
University Federico II of Naples
Naples
Italy


Elena Sinkovskaya M.D.
Department of Obstetrics and Gynecology
Eastern Virginia Medical School
Norfolk
VA
USA


Fabrizio Taddei M.D.
Department of Obstetrics and Gynecology
Azienda Ospedaliera “C.Poma”
Mantova
Italy


Tullia Todros M.D.
Department of Obstetrics and Gynecology
Maternal-Fetal Medicine Unit
University of Turin
Turin
Italy


Alessandra Toscano M.D.
Department of Pediatric Cardiology and Cardiac Surgery
Bambino Gesu’ Hospital
Rome
Italy


Dan V. Valsky M.D.
Department of Obstetrics and Gynecology
Hadassah-Hebrew University Medical Centers – Mt. Scopus
Jerusalem
Israel


Nicola Volpe M.D.
Fetal Medicine Unit
Di Venere and Sarcone Hospitals. ASL Bari
Bari
Italy


Paolo Volpe M.D.
Fetal Medicine Unit
Di Venere and Sarcone Hospitals. ASL Bari
Bari
Italy


Alina Weissmann-Brenne M.D.
Department of Obstetrics and Gynecology
The Chaim Sheba Medical Center Tel Hashomer
Affiliated with the Sackler Faculty of Medicine
Tel Aviv University
Tel Aviv
Israel


Simcha Yagel M.D.
Department of Obstetrics and Gynecology
Hadassah-Hebrew University Medical Centers – Mt. Scopus
Jerusalem
Israel


Lami Yeo M.D.
Department of Obstetrics and Gynecology
Wayne State University School of Medicine
Perinatology Research Branch Intramural Division, NICHD, NIH, DHHS
Hutzel Women’s Hospital
Detroit
MI
USA




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