Atlas of Fetal Echocardiography Manish R Pandya
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1Atlas of FETAL ECHOCARDIOGRAPHY2
3Atlas of FETAL ECHOCARDIOGRAPHY
Second Edition
Manish R Pandya MD FICOG FICMCH (Gynecology) Endoscopy (CICE France) ART (EART, Mumbai; CRM, Cleveland, Ohio, USA) Professor and Head Department of Obstetrics and Gynecology CU Shah Medical College, Surendranagar, Gujarat, India www.manishivf.com, www.drmanishpandya.com Foreword S Suresh FRCOG (Hon)
4
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Atlas of Fetal Echocardiography
First Edition: 2011
Second Edition: 2015
9789351524762
Printed at
5Dedicated to
My Patients who kept full faith in me and encouraged me indirectly to write the book.
My family members without whose constant inspiration and cooperation this attempt would not have been completed.
7Foreword
I am very happy to note that the second edition of Atlas of Fetal Echocardiography is being published. The author has taken efforts to compile a comprehensive book starting from the embryology of the heart to an illustrative frequently asked questions, chapter on cardiac anomalies which is easy to comprehend by the readers. For beginners, this illustrative book will serve as a guide to understand the various views in fetal echocardiography and also the normal and abnormal patterns. The author has made an effort to “Simplify” a complex subject and has placed emphasis on the importance of pattern recognition which is what an atlas is expected to do. The colorful line diagrams with explicit anatomical markings are easy-to-understand and help to retain concepts in memory. My best wishes to Dr Manish R Pandya for this effort and congratulate him on bringing out the second edition by which many students of this subject will benefit.
S Suresh FRCOG (Hon)
Director MEDISCAN Systems
197, Dr Natesan Road, Mylapore
Chennai, Tamil Nadu, India
8
9Preface
With the second edition, Atlas of Fetal Echocardiography completed four years of service to its readers.
Ultrasonography and echocardiography are two common tools for the obstetricians in their day-to-day practice. The use is limited to just biometry and routine use for detecting anomaly. The days have come now with lots of research and development in this particular field. With color Doppler high resolution machine spatiotemporal image correlation (STIC) and continuous wave Doppler, it is very easy to scan fetal heart and to detect anomalies.
With routine ultrasonography (USG) machine at least my goal to make sonographers to detect something is not normal in fetal heart… It makes us PASSS… in my efforts (Position, Axis, Size, Symmetry and Squeeze).
Advance technologies as well as increased capability of sonographers and sonologists have expanded use of USG as diagnostic tool for evaluation of fetal anatomy and fetal heart with the exception of the newly described “limited scan” a fetal survey has become an integral part of any basic or targeted (comprehensive) USG examination.
Today's need save for all care for all and with my machine, I am able to save one out of hundred babies born with congenital heart defect and many could be far better helped, if diagnosis is made earlier. It is not confident for anybody to give 100% accuracy in report but still we can diagnose major cardiac defect easily and guide patients accordingly.
The fetal heart undergoes complex developmental changes in the first few weeks of gestation and become fully developed by 8 weeks of embryonic life. Congenital heart disease (CHD) in fetus may be the result of abnormal cardiac development during embryonic life.
If we look at postnatal data, it shows frequency of chromosomal abnormalities has been estimated around 5–10%. Down syndrome associated with cardiac anomaly shows around 13%. The frequency of abnormal karyotype in fetus with cardiac defects is even higher. About 30–40%, chromosomal abnormalities are associated with cardiac defects.
Real-time imaging of the fetal heart first is considered feasible in the 1980s.
The addition of four-chamber view as a part of routine antenatal screening has helped clinicians a lot to diagnose complex cardiac anomalies.
The diagnosis of complex cardiac anomalies calls for considerable operator expertise and experience.
In the book, I have tried to explain the basic use of these new modalities and I am sure that it will be extremely useful to the newcomers entering in the new field of diagnostic procedures and also to those experienced obstetricians to give something new.
10The second edition is updated and augmented with Nutshell at the end of each chapter for easy points to remember and one new chapter of abnormal heart presentations with tomographic ultrasound imaging (TUI) and 3D images for easy understanding.
There is always scope for improvements in any work and I will be highly obliged by suggestions and comments from learned teachers and students at drmanish.pandya@gmail.com or www.manishivf.com or www.drmanishpandya.com
I sincerely hope that this atlas will satisfy your academic success.
Manish R Pandya
11Acknowledgments
I am thankful to: