Editor Jyotsna Gandhi MD Associate Professor Department of Obstetrics and Gynecology Mount Sinai School of Medicine,
New York, USA
Chief, Obstetrical Ultrasound Elmhurst Hospital Center, New York USA
Co-editor Wyman Lai MD
Professor, Department of Pediatrics Mount Sinai School of Medicine, New York, USA
Director, Pediatric Cardiology Mount Sinai Medical Center, New York, USA
Assistant Editor Swati Gandhi MD Attending Pediatrician Herkimer County Health Center Basset Health Care: A Teaching Affiliate of Columbia University Cooperstown, New York, USA
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
B-3 EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi 110 002, India
Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021, +91-11-23245672
Rel: 32558559 Fax: +91-11-23276490, +91-11-23245683
E-mail: jaypee@jaypeebrothers.com Visit our website: www.jaypeebrothers.com
Branches
- 2/B, Akruti Society, Jodhpur Gam Road Satellite,Ahmedabad 380015, Phones: +91-079-26926233, Rel: +91-079-32988717Fax: +91-079-26927094 e-mail: jpamdvd@rediffmail.com
- 202 Batavia Chambers, 8 Kumara Krupa Road, Kumara Park EastBangalore 560 001, Phones: +91-80-22285971, +91-80-22382956, Rel: +91-80-32714073Fax: +91-80-22281761 e-mail: jaypeemedpubbgl@eth.net
- 282 IIIrd Floor, Khaleel Shirazi Estate, Fountain Plaza, Pantheon RoadChennai 600 008, Phones: +91-44-28193265, +91-44-28194897, Rel: +91-44-32972089Fax: +91-44-28193231, e-mail: jpchen@eth.net
- 4-2-1067/1-3, Ist Floor, Balaji Building, Ramkote Cross Road, Hyderabad 500 095Phones: +91-40-66610020, +91-40-24758498Rel: +91-40-32940929 Fax: +91-40-24758499, e-mail: jpmedpub@rediffmail.com
- No. 41/3098, B & B1, KURUVI Building, St. Vincent Road, Kochi 682 018 (Kerala)Phones: +91-0484-4036109, +91-0484-2395739, +91-0484-2395740e-mail: jaypeekochi@rediffmail.com
- 1-A Indian Mirror Street, Wellington SquareKolkata 700 013, Phones: +91-33-22451926, +91-33-22276404, +91-33-22276415Rel: +91-33-32901926, Fax: +91-33-22456075, e-mail: jpbcal@dataone.in
- 106 Amit Industrial Estate, 61 Dr SS Rao Road, Near MGM Hospital, ParelMumbai 400 012, Phones: +91-22-24124863, +91-22-24104532, Rel: +91-22-32926896Fax: +91-22-24160828 e-mail: jpmedpub@bom7.vsnl.net.in
- “KAMALPUSHPA” 38, Reshimbag Opp Mohota Science College, Umred RoadNagpur 440 009 (MS), Phone: Rel: 3245220, Fax: 0712-2704275e-mail: jaypeenagpur@dataone.in
Fetal Cardiology for Obstetricians
© 2007, Jyotsna Gandhi
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 editors and the publisher.
First Edition: 2007
9788180619878
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset
5Dedicated to
All those who have spent their lifetime in serving our children and their mothers.
Their scientific expertise, curiosity to investigate uncharted territory and ability to work in multispecialty team to achieve a better outcome for babies with congenital heart diseases deserves our admiration.6
7Contributors
- Victoria Belogovkin MD
- Fellow, Maternal Fetal Medicine
- Mount Sinai School of Medicine
- New York, USA
- Barry Brown MD
- Associate Professor
- Department of Obstetrics and Gynecology
- Mt. Sinai School of Medicine, New York
- Vice Chairman, Department of Obstetrics and Gynecology and Reproductive Science
- Mount Sinai, Hospital New York
- Director, Department of Obstetrics and Gynecology
- Elmhurst Hospital Center, New York, USA
- Andrew Ditchik MD
- Assistant Professor, Department of Obstetrics and Gynecology, Mount Sinai School of Medicine, New York
- Associate Director, Department of Obstetrics and Gynecology, Elmhurst Hospital Center, New York, USA
- Keith Edelman MD
- Associate Professor
- Mount Sinai School of Medicine, New York
- Director, Maternal Fetal Medicine
- Mount Sinai Hospital, New York, USA
- Anne Ferris MD
- Pediatric Cardiology
- New York Presbyterian Hospital
- Columbia University College of Physicians and Surgeons, New York, USA
- Jyotsna Gandhi MD
- Associate Professor
- Department of Obstetrics and Gynecology Mount Sinai
- School of Medicine, New York, USA
- Chief, Obstetrical Ultrasound Elmhurst Hospital Center,
- New York, USA
- Fredrick A Gonzales MD
- Chief of Obstetrics
- Elmhurst Hospital Center
- Mount Sinai School of Medicine
- New York, USA
- James Huhta MD
- Academic Professor of Pediatrics and Obstetrics and Gynecology
- Daicoff-Andrews Chair in Perinatal Cardiology
- University of South Florida, College of Medicine, USA
- Wyman Lai MD
- Professor, Department of Pediatrics
- Mount Sinai School of Medicine, New York
- Director, Pediatric Cardiology
- Mount Sinai Medical Center, New York, USA
- Lytrivi Lai MD
- Pediatric Cardiology
- Mount Sinai Medical Center
- Mount Sinai School of Medicine
- New York, USA
- Isha Mehta MD
- Clinical Assistant Professor of Obstetrics and Gynecology
- Mount Sinai School of Medicine, New York
- Chief of Gynecology
- Elmhurst Hospital Center, New York, USA
- Dev Maulik MD PhD
- Chairman
- Department of Obstetrics and Gynecology
- Winthrop University Hospital
- Professor of Obstetrics and Gynecology
- Prema Ramaswamy MD
- Assistant Professor of Obstetrics and Gynecology
- Mount Sinai School of Medicine
- Co-Director, Pediatric Cardiology
- Maimonades Medical Center, Brooklyn, New York, USA
- Amisha Shah MS CGC
- Genetic Counselor
- Elmhurst Medical Center
- Mount Sinai School Of Medicine, New York, USA
- Lyn Simpson MD
- Associate Professor, Obstetrics and Gynecology
- Columbia University College of Physicians and Surgeons, Maternal Fetal Medicine
- Dept of Obstetrics and Gynecology
- Director of Obstetrics and Gynecology Ultrasound
- Medical Director, The Center of Pediatrics
- Program Director, Maternal Fetal Medicine Fellowship
- Dept of Obstetrics and Gynecology
- Columbia University Medical Center
- New York, USA
- Sangita Sharma MD
- Director, Pediatric Cardiology
- Elmhurst Medical Center
- Pediatric Cardiology
- Mount Sinai Medical Center, New York
- Mount Sinai School of Medicine, New York, USA
- Shubhika Srivastava MD
- Pediatric Cardiology
- Mount Sinai Medical Center
It is with great pleasure that I send this foreword for the book on ‘Fetal Cardiology.’
It is a brilliant monogram on an important issue in obstetric care. Edited by two professors devoted to the subject and with contributions from well-known academicians with vast experience, this book will no doubt serve as a reference manual. It is a treasure trove of information from embryology, imaging sciences and clinical medicine.
I am especially proud of the contributions made by authors of Indian origin who have made their homes in USA. Science knows no geographic barriers or frontiers. Those who are devoted to the pursuit of knowledge will do so from anywhere in the world. However, the facilities, the infrastructure, the institutional support and the scientific atmosphere of one's workplace contribute significantly.
The scientific developments and the knowledge thereof translate eventually into good clinical practice. The ultimate beneficiary of this will be the patient and her as yet unborn child. Let us hope many more babies affected by cardiac defects will find a hope of a good life through the pages of this book.
I congratulate all the contributors of this magnificent book. A very special appreciation goes to the editors for making this effort into a reality.
The book will certainly be appreciated internationally. However, it will find a very special appreciation in India. There is a large medical fraternity in India which serves a population of one billion people and they will certainly benefit from this book.
To all readers, I wish “Happy Reading.”
Usha B Saraiya MD DGO FIAC FICS FICOG
Hon. Obstetrician, Gynecologist and Colposcopist
Sir HN Hospital, Mumbai
Consultant Oncologist
Cama and Albless Hospital, Mumbai
11From the Desk of Jasmin Moshirpur …
Jyotsna Gandhi joined our faculty 5 years ago as Senior Perinatologist and Director of Obsteric Ultrasound. Her vast experience has enabled us to significantly advance our services to our large multiethnic population. She is a devoted teacher and perinatolgist who has enabled us to take full advantage of the 21st century state-of-the-art technology in perinatal care. Her superior abilities are matched by a pleasant personality that encourages her students, house physicians and colleagues to seek her expertise and guidance in managing patients
I am pleased that she is sharing her clinical experience in this book and I feel privileged to write this brief introduction about her.
Jasmin Moshirpur MD
Professor
Obstetrics, Gynecology and Reproductive Sciences
Mount Sinai School of Medicine
Dean/Medical Director of Queens Health Network
13Preface
Why do we need a book on fetal cardiology for obstetricians? Congenital heart diseases are the most frequent fetal anomalies and yet most of us are not adequately trained to examine the fetal heart. We must do better than that.
Since the advent of high resolution ultrasound our ability to image the fetal heart has improved dramatically with the advent of 2D, 3D, and 4D ultrasonography.
Documentation of basic cardiac anatomy is now a requirement during fetal anatomy examination. Hence, fetal heart assessment has entered the realm of the general obstetrician. Additionally, the advent of Doppler flow assessment has enabled us to evaluate fetal cardiovascular physiology in high risk infants that can be included in our program of fetal monitoring in very sick fetuses. Moreover, cardiovascular changes may help us recognize compromised fetuses and plan delivery in a timely manner. Fetal cardiology, hence, is an integral component of an obstetrician's world.
My interest in fetal heart was stimulated by working with Dr Huhta in Philadelphia. Thereafter, I met Dr Lindsey Allen and heard about her role as teacher of fetal heart to the entire United Kingdom. Her dedication to this area is unlimited. She was once kind enough to spend an entire day teaching hands on fetal heart sonography at a conference organized at our institution. Recognizing the potential impact of evaluating fetal cardiovascular function with Doppler flow studies, one cannot but realize that these parameters may one day become routine components of fetal monitoring programs for special fetuses.
I have tried to stimulate interest of obstetricians in India and elsewhere in fetal heart. This book focuses on issues frequently encountered by general obstetrician, more to his interest as in fetal heart function and high risk patient management, counseling, etc. I hope this book is helpful to all our colleagues and they will enjoy having it in their collection.
Jyotsna Gandhi
14Acknowledgements
Dr Wyman Lai and I, greatly acknowledge the involvement of all those who contributed to this book, Fetal Cardiology for Obstetricians, both pediatricians and my colleagues in obstetrics. Their dedicated efforts in time and skill are invaluable to publication of this book. We also appreciate the enormous secretarial help of Wendy Lerchenmueller without whom the book could never have been organized. Moreover, I thank Dr Barry Brown for his encouragement and support during preparation of the book. Finally, salutes to my husband and children who tolerated all the ups and downs in my mood as the book progressed to fruition.