Fetal Cardiology for Obstetricians Jyotsna Gandhi, Wyman Lai, Swati Gandhi
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1Fetal Cardiology for Obstetricians2
3Fetal Cardiology for Obstetricians
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
4Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
B-3 EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi 110 002, India
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E-mail: jaypee@jaypeebrothers.com Visit our website: www.jaypeebrothers.com
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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.
This book has been published in good faith that the material provided by contributors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and editors will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only.
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 Foreword
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
President of FOGSI, 2002–200310
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
New York, USA12
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.