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Fetal Cardiology for Obstetricians
Jyotsna Gandhi, Wyman Lai, Swati Gandhi
CHAPTER 1:
Congenital Heart Disease Overview
INTRODUCTION
Relevance of Fetal Cardiac Disease to Obstetricians
Magnitude of the Problem
RECENT TRENDS IN DIAGNOSIS OF CONGENITAL HEART DISEASE
Congenital Heart Defects and Extracardiac Anomalies
Relationship with Genetic Diseases
First Trimester Diagnosis of CHD Using Nuchal Translucency
Most Frequent Anomalies: Diagnosis and Limitations
DOES PRENATAL DIAGNOSIS IMPROVE OUTCOME?
EVOLUTION OF FETAL CARDIOLOGY: PRESENT AND FUTURE
CHAPTER 2:
Normal/Abnormal Fetal Cardiac Development and Physiology
INTRODUCTION
Failure of the AVS to move Rightwards
Failure of Conotruncal Rotation Leftward and Septation
SYSTEMIC VEINS
Clinical Correlation
PULMONARY VEINS
THE ATRIA
Clinical Correlation
AV CUSHIONS
Clinical Correlation
THE AORTIC ARCHES
CHAPTER 3:
Genetics and Congenital Cardiac Disease
INTRODUCTION
DOWN SYNDROME (TRISOMY 21)
EDWARD'S SYNDROME (TRISOMY 18)
PATAU'S SYNDROME (TRISOMY 13)
TURNER'S SYNDROME
DELETION OF 22Q11
WILLIAM'S SYNDROME
THROMBOCYTOPENIA ABSENT RADII (TAR) SYNDROME
CORNELIA DE LANGE (BRACHMANN-DE LANGE) SYNDROME
VACTERL
CHARGE
HETEROTAXY SYNDROME (ASPLENIA OR POLYSPLENIA SYNDROME)
NOONAN'S SYNDROME
HOLT-ORAM SYNDROME (THE HEART-HAND SYNDROME)
SKELETAL DYSPLASIA
METHYLENETETRAHYDROFOLATE REDUCTASE (MTHFR) GENE
TERATOGENS
GENETIC COUNSELING AND PRENATAL DIAGNOSIS
CHAPTER 4:
Indications for Fetal Echocardiography
INTRODUCTION
MATERNAL INDICATIONS
Metabolic Disorders
Diabetes Mellitus
Phenylketonuria (PKU)
Methylenetetrahydrofolate reductase (MTHFR) deficiency
Autoimmune Disorders
Teratogens
Vitamin A Analogs
Alcohol
Cocaine
Anticonvulsants
Lithium
Infections
FAMILIAL INDICATIONS
FETAL INDICATIONS
Abnormal Cardiac Screening
Abnormal Nuchal Translucency
Sacrococcygeal Teratomas
Cystic Hygroma
Twin-twin Transfusion Syndrome
Non-immune Hydrops and Severe Polyhydramnios
Other Anomalies
Fetal Arrhythmias
GENETIC INDICATIONS
CONCLUSIONS
CHAPTER 5:
Normal Fetal Heart/Fetal Echocardiography
INTRODUCTION
SCREENING
Screening Low-risk Populations
High-risk Populations for Fetal Echocardiography
Normal Fetal Heart Anatomy
TECHNIQUES
Two-dimensional Cross-sectional Imaging
Doppler Imaging of the Fetal Heart
M-mode Echocardiography
NEW IMAGING MODALITIES AND THE FETAL HEART
EXPECTATIONS FROM CARDIAC SCREENING (TABLE 5.1)
Four-chamber View
Extended Exam including Outflow Tract Views
Fetal Echocardiography
CONCLUSIONS
CHAPTER 6:
Obstetrical Ultrasound and Fetal Cardiac Disease
OVERVIEW OF OBSTETRICAL ULTRASOUND
FETAL ANATOMY
Fetal Survey: Normal versus Abnormal
Fetal Head, Neck, Face
Chest
Abdomen
Spine
Extremities
Gender
GENETIC DISEASE
CONCLUSIONS
CHAPTER 7:
Abnormalities of the Atrial Septum, Atrioventricular Junction and Ventricular Septum
INDUCTION
ATRIAL SEPTAL DEFECT
VENTRICULAR SEPTAL DEFECT
ATRIOVENTRICULAR CANAL DEFECT
TRICUSPID VALVE ANOMALIES
Tricuspid Atresia
Ebstein's Anomaly
UHL ANOMALY
MITRAL VALVE ANOMALIES
Congenital Mitral Stenosis
Cor Triatriatum
Congenital Mitral Insufficiency
DOUBLE INLET SINGLE LEFT VENTRICLE
CHAPTER 8:
Abnormalities of the Ventriculoarterial Junction and Great Arteries
INTRODUCTION
AORTIC VALVE ANOMALIES
Aortic Stenosis
Aortic Atresia
AORTIC ARCH ANOMALIES
Coarctation of the Aorta and Aortic Arch Hypoplasia
Interrupted Aortic Arch
Abnormalities of Aortic Arch Position and Branching
AORTICO-LEFT VENTRICULAR TUNNEL
PULMONARY VALVE ANOMALIES
Pulmonary Stenosis
Pulmonary Regurgitation
Pulmonary Atresia with Intact Ventricular Septum
TETRALOGY OF FALLOT
Tetralogy of Fallot with Pulmonary Atresia
Tetralogy of Fallot with Absent Pulmonary Valve
Tetralogy of Fallot with Complete Atrioventricular Canal
TRANSPOSITION OF THE GREAT ARTERIES
DOUBLE OUTLET RIGHT VENTRICLE
TRUNCUS ARTERIOSUS
ISOLATED DUCTUS ARTERIOSUS ANEURYSM
CHAPTER 9:
Miscellaneous Cardiovascular Lesions
ABNORMALITIES OF VENOUS CONNECTIONS
Systemic Venous Anomalies
Pulmonary Venous Anomalies
HETEROTAXY SYNDROME
CARDIOMYOPATHY
Fetal Presentation
Dilated Cardiomyopathy
Hypertrophic Cardiomyopathy
Restrictive Cardiomyopathy
FETAL CARDIAC TUMORS
VENTRICULAR ANEURYSMS AND DIVERTICULA
CARDIOVASCULAR LESIONS IN TWIN-TWIN TRANSFUSION SYNDROME
CHAPTER 10:
Fetal Congestive Heart Failure
ABSTRACT
INTRODUCTION
FACTORS AFFECTING PERINATAL CARDIAC OUTPUT
HYDROPS FETALIS
Cardiac Failure in the Fetus
PROGNOSIS OF FETAL HEART FAILURE-MARKERS OF FETAL MORTALITY
THE CARDIOVASCULAR PROFILE SCORE
Hydrops
Umbilical and Ductus Venosus Doppler
Cardiomegaly
Abnormal Myocardial Function
Arterial Doppler:Redistribution of Fetal Cardiac Output
NEW ADVANCES
TREATMENT
CONCLUSIONS
CHAPTER 11:
Functional Fetal Cardiology and Echocardiography in High Risk Pregnancies
INTRODUCTION
FETAL CIRCULATION
FETAL ECHOCARDIOGRAPHY IN HIGH RISK PEGNANCIES
Two-dimensional Echocardiography
M-Mode Echocardiography
Doppler Echocardiography
CARDIAC CIRCULATION
Atrioventricular Valves
Aorta and Pulmonary Artery (Outflow Tracts)
Ductus Arteriosus (DA)
Middle Cerebral Artery
Venous Circulation
Inferior Vena Cava (IVC)
Ductus Venosus Flow
Umbilical Venous Flow
Umbilical Arterial Doppler Flow
FETAL HEMODYNAMIC ASSESSMENT BY ECHOCARDIOGRAPHY IN HIGH RISK PREGNANCIES
Intrauterine Growth Retardation
Umbilical Arterial Doppler in IUGR
Middle Cerebral Artery in IUGR
Cardiac Hemodynamics and Surveillance in IUGR
Venous Doppler in IUGR
Timing of Delivery in IUGR
Maternal Diabetes
Cardiac Malformations in IDMs
Functional Cardiac Disease in IDMs
Functional Echocardiography in IDMs
Peripheral Vessels
Venous Circulation
Discordant Twins and Twin-twin Transfusion
FETAL ANEMIA
MATERNAL DRUGS
Indomethacin
Beta-agonists
CHAPTER 12:
Management of Pregnancy Complicated by Structural Congenital Cardiac Disease
INTRODUCTION
MANAGEMENT OF PREGNANCY COMPLICATED BY CONGENITAL HEART DISEASE
MATERNAL FETAL MANAGEMENT AND OUTCOME
FETAL ARRHYTHMIAS
Tachyarrhythmias
Bradyarrhythmias
Therapeutic Approach to Fetal Arrhythmia
MATERNAL FETAL MANAGEMENT OF STRUCTURAL HEART DISEASES
Fetal surgery
Maternal Management
CONCLUSIONS
CHAPTER 13:
Obstetrical Management of Pregnancy with Congenital Heart Disease
INTRODUCTION
DIAGNOSIS OF CHD
Who should have Detailed Fetal Echocardiography?
Prenatal Screening for CHD
Prenatal Sonography for Cardiac Screening for CHD
Accurate Assessment of Fetal Cardiac Status
Evaluation of Chromosomal Anomalies
COUNSELING
PERINATAL MANAGEMENT
PRENATAL CARE
PRENATAL SONOGRAPHY
LESIONS SPECIFIC ISSUES
Fetal Arrhythmias
Supraventricular Tachycardia
Management of Pregnancy with Fetal Myocardial Dysfunction
Intrapartum Management in Structural CHD
SUMMARY
CHAPTER 14:
New Techniques in Fetal Echocardiography
INTRODUCTION
EVOLUTION OF THREE-DIMENSIONAL ECHOCARDIOGRAPHY
BASIC PRINCIPLES OF THREE-DIMENSIONAL SONOGRAPHY
Real Time three-Dimensional Echocardiography with Two-dimensional Matrix Array
Two Dimensional Matrix Array–Fetal Application of the Technique
RECONSTRUCTED THREE-DIMENSIONAL ULTRASOUND
Fetal Echocardiography with STIC Technology
CONCLUSIONS
INDEX
TOC
Index
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