Fetal Echocardiography Rakesh Gupta
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1Step by Step Fetal Echocardiography
2Step by Step Fetal Echocardiography
Rakesh Gupta MD FIAE FICP Fellow Cardiology (USA) Echo and Color Doppler Centre Sunder Lal Jain Hospital Complex Delhi, India
3Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
EMCA House, 23/23B Ansari Road, Daryaganj
New Delhi 110 002, India
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Step by Step Fetal Echocardiography
© 2006, Rakesh Gupta
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2006
9788180618222
Typeset at JPBMP typesetting unit
Printed at Gopsons
4
This book is dedicated in the memory of my role model, my beloved grandfather, a great guardian and a devoted preacher whom I miss almost every day
Late Shri Jiya Ram Ji
5Foreword
The impact of echocardiography, together with Doppler and Color flow mapping, on the clinical practice has continuously grown to such an extent that it has now emerged as the most integrated tool in day-to-day clinical cardiology. There is no other technique which can match its versatility and the wealth of information it provides. In today's rapidly evolving fields of cardiac surgery, interventional cardiology, electrophysiology, heart failure, cardiac anesthesiology, clinical cardiology, etc. Echo-Doppler imaging has become a key component not only in establishing a diagnosis, prognosis but is critical to medical and surgical therapeutic decision-making.
As echocardiography has gained acceptance and applicability, newer techniques have emerged. Fetal echocardiography is one such technique which has made a tremendous impact in clinical practice. A prenatal diagnosis has significant social, psychological and management implications. An increasing number of fetal interventions are being performed now. As such fetal echocardiography, though a difficult imaging technique, needs a precise diagnosis and clear understanding of technique and interpretation.6
Dr Rakesh Gupta has done a commendable job in writing this book in a very basic manner with a step up approach. The various chapters have been prepared in a simple style, well-illustrated and easy to understand. I am confident that its reading will not be a labour but a joy.
Dr (Col) SK Parashar
President-Elect
Cardiological Society of India
Past President
Indian Academy of Echocardiography
7Preface
Fetal echocardiography has evolved over a period of time both for diagnostic as well as therapeutic purposes. With ever growing industrialization in India, more and more people are opting for smaller families and in the quest of knowing about their baby's heart, especially in circumstances, where their previous child had heart ailment at birth, a need was felt for centers doing fetal echocardiography.
When I started doing fetal echocardiography into my practice, I could not locate many books of fetal echocardiography and hence I thought, why not give a shape for one? And here is one, where any body can start doing fetal echocardiography and by the time one finishes with this, I shall be presenting another one with examples.
I hope this step by step approach shall be very useful for pediatricians, radiologist, sonographers, and all others involved in the investigations of fetal heart diseases.
Rakesh Gupta
8Acknowledgements
I would like to acknowledge the support that I have received from my colleagues, family and friends in completing this manuscript. No work can be complete without proper guidance and teamwork.
I am grateful to my father-in-law, Dr DK Gupta for guiding me into the field of echocardiography. Subsequently I was thoroughly blessed by the “father of echocardiography in India”, Col SK Parashar, who has been my mentor for more than 10 years and helped me in all my endeavors.
Echo centre and its staff has been the backbone of this book. I am really thankful to Dr Alpana Bhatnagar, my colleague at centre for her tremendous help. I am also thankful to my other staff of echo centre for their understanding and hard work especially Ms Reena, Ms Swati, Mr Amar, Mr Shrikant, Mr Neeraj Sharma and Ms Anshu in writing this manuscript.
Shri JP Vij, Chairman and Managing Director of M/s Jaypee Brothers Medical Publishers (P) Ltd. has been the driving force behind this project. He first invited me to author this book almost one year ago. I thank him for his patience, encouragement and excellent publishing skills.
I am thankful to President, HMB, Sunder Lal Jain Hospital, Dr Chanderprakash and Secretary Mr VK Jain 9for providing me moral support throughout this project. I am also thankful to number of my friends especially Dr Pritam Gupta, Dr Sunil Mangla, Dr VK Bindal, Dr RK Narang.
Finally I would like to acknowledge the enormous sacrifices that my parents, Shri Om Prakash and Smt Raj Rani, have made to help me achieve my goal. Most importantly I offer my deep appreciation and gratitude to my wife Ms. Mona and my children Sanchit and Tanya for their quiet tolerance and unfailing support.
Last but not the least, I am thankful to Almighty God for all his support in completing this work.
11Introduction
Heart development occurs as a result of an interaction of genes, environment, and chance. An abnormal interaction of any of these process may lead to a congenital heart defect.
It is usually defined as a gross structural abnormality of the heart or intrathoracic great vessels that is actually or potentially of functional significance. Congenital heart disease is the most common congenital abnormality found among live births.
Because development of the heart is an interaction of genes, environment and chance, approximately 70 to 85% of cases of congenital heart disease have a multifactorial cause.
To understand fetal echocardiography, it is essential to delineate the etiology and pathogenesis of congenital heart disease which requires an understanding of both normal and abnormal cardiac development.