FETAL HEART Screening, Diagnosis and Intervention
FETAL HEART Screening, Diagnosis and Intervention
Editors
Cihat Şen MD
Founder and Professor Department of Perinatal Medicine, Obstetrics and Gynecology Perinatal Medicine Center Memorial Bahçelievler Hospital, Istanbul, Turkey Perinatal Medicine Foundation, Istanbul Cerrahpaşa Medical School, Istanbul University, Turkey
Milan Stanojevic MD PhD
Head Department of Neonatology Medical School University of Zagreb Sveti Duh Clinical Hospital Zagreb, Croatia
Foreword
Asim Kurjak
Jaypee Brothers Medical Publishers (P) Ltd
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Fetal Heart: Screening, Diagnosis and Intervention
First Edition: 2020
9789352703326
Printed at
- Badreldeen Ahmed MD MBChB
- Professor of Clinical Obstetrics and Gynecology
- Weill Cornell Medical College
- Doha, Qatar
- Director
- Feto-Maternal Centre
- Doha, Qatar
- Cihat Şen MD
- Founder and Professor
- Department of Perinatal Medicine, Obstetrics and Gynecology
- Perinatal Medicine Center
- Memorial Bahçelievler Hospital
- Istanbul, Turkey
- Perinatal Medicine Foundation, Istanbul
- Cerrahpaşa Medical School, Istanbul University, Turkey
- Ebru Tarm MD
- Professor
- Perinatal Medicine Center
- Adana, Turkey
- Emre Zafer MD
- Clinical Genetics and Clinical Cytogenetics Specialist
- Assistant Professor
- Department of Obstetrics and Gynecology
- Aydin Adnan Menderes University School of Medicine, Turkey
- Gökhan Göynümer MD
- Professor
- Subspecialist on Perinatology
- Head
- Department of Obstetrics and Gynecology
- Düzce University Medicine Faculty
- Turkey
- Halil Gursoy Pala MD
- Associate Professor
- University of Health Sciences
- Tepecik Training and Research Hospital
- Department of Obstetrics and Gynecology
- Division of Perinatology
- Izmir, Turkey
- Milan Stanojevic MD PhD
- Head
- Department of Neonatology
- Medical School University of Zagreb
- Sveti Duh Clinical Hospital
- Zagreb, Croatia
- Murat Yayla MD
- Professor
- Perinatal Medicine Center
- Acibadem Hospital
- Istanbul, Turkey
- Olus Api MD
- Professor
- Perinatal Medicine Center
- American Hospital
- Istanbul, Turkey
- Orhan Uzun MD RFCP
- Consultant Pediatric and Fetal Cardiologist
- Consultant Pediatric Cardiac
- Electrophysiologist
- University Hospital of Wales
- Professor School of Engineering and Sport Sciences
- Swansea University
- Cardiff, Wales, UK
- Sertaç Esin MD
- Associate Professor
- Department of Perinatal Medicine
- Başkent University Medical Faculty
- Ankara, Turkey
- Talat Umut Kutlu Dilek MD
- Professor
- Department of Obstetrics and Gynecology
- Acibadem University School of Medicine
- Istanbul, Turkey
- Toshiyuki Hata MD PhD
- Professor and Chairman
- Department of Perinatology and Gynecology
- Kagawa University
- Graduate School of Medicine, Japan
Congenital heart defects are among the most frequent congenital anomalies with severe impact on mortality and morbidity. Screening of many congenital anomalies of other organs in the last several decades has resulted in the increase of detection rate but not in the case of heart defects. It is clear that screening of the heart defects should be performed by the medical professionals who care for most of the pregnant women while diagnosis of heart defects should be done by experts in fetal echocardiography who should also specify what kind of heart defect the fetus has. Fetal Heart: Screening, Diagnosis, and Intervention is giving the means for the screening of the heart defect in both first and second trimesters. The interested readers will find much useful practical information about how to perform prenatal fetal heart screening systematically. Complex aspects of complete care for the patients with heart disease are clearly described and discussed in this very useful and user-friendly monograph dedicated to healthcare professionals caring for the pregnant women at the basic level of care, performing prenatal anomaly scan screening.
The two editors, Professor Cihat Şen (Obstetrician), and Professor Milan Stanojevic (Neonatologist), are both leading figures in fetal echocardiology. They indeed collected top authors; most of them are the world names in the assessment of fetal heart.
This book was much wished by our publisher M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, and I am sure that they and their future readers will truly enjoy reading hot and actual topics from this exciting field. It is with great pleasure to introduce this book in high belief that the book will have many subsequent new editions.
Asim Kurjak
Founder and Director
Ian Donald Inter-University School of Medical Ultrasound
Zagreb, Croatia
Preface
Fetal Heart: Screening, Diagnosis, and Intervention is prepared for obstetricians who are dealing daily clinical workup and dedicating their time for and to give a better antenatal care to their pregnant patients. With the improvement of technical quality and more scientific evidence, ultrasound evaluation is not an imaging modality in Obstetrics and Gynecology anymore. Ultrasound is a tool that is giving an opportunity to use every examination methods such as inspection, palpation, percussion, auscultation, and additional measurable parameters to evaluate the fetus and the mother. Ultrasound is a technology for obstetricians to see and measure things to establish the normal morphological and circulation anatomy, growth, etc. If there is something wrong or abnormal or out of limits, then we can make dedicated examination and management for this matter. On the hand of obstetrician and gynecologist, ultrasound is not an imaging tool but an examination tool. For this reason, obstetricians have to be able to competent how to look at, evaluate, and measure of fetal organs, systems, embryonal and fetal evolution at every stage for anatomy, physiology, pathophysiology, diagnosis, intervention, and management. If the problem needs more competence and experience, a perinatal expert could be consulted or referred.
Fetal heart has been a challenging issue for obstetricians for long time because of low detection rate of fetal heart abnormalities in the past. But now we are able to make complete fetal heart examination and to pick up every major fetal heart defects according to their diagnosable period. There are two steps for detection of fetal heart abnormalities: First, to establish a normal four-chamber view and three-vessel view which means that fetal heart anatomy looks like normal. If there is no normal four-chamber view and three-vessel view, it means that it does not look like normal, and it should be evaluated in a comprehensive way by perinatal expert. Therefore the duty of an obstetrician is to establish normal four-chamber view and three-vessel view or suspect an abnormality that needs to be evaluated in a detailed examination by perinatal expert whether it is diagnosed normal or abnormal at the end of the day.
To be competent for obstetrician to examine the fetal heart, there are some important points and conditions that have to be taken care and followed for a standard examination of fetal heart. Also obstetricians need to store those images to show later on, what they did in fetal examination, according to medical standard. Otherwise a medicolegal issue can be headache in some cases.
For this purpose, we decided to prepare a book which obstetricians can enjoy to update, refresh, and increase their knowledge and competence at the time of fetal heart examination according to clinical standard with evidence-based standard practice. Not just about anatomy and circulation, also to enjoy to make a diagnosis in most major fetal heart abnormalities and some other fetal conditions related to fetal heart.
Every obstetrician can establish whether fetal heart looks like normal or not. Only prerequisite is a standard examination approach which apical view should be taken and heart should be made big enough as much as possible at least 2/3 of the screen. If the position of the baby is not proper, it should be patient enough to get the most proper position that the fetus will take. Also the doctor who is making the fetal examination could appreciate the more knowledge about normal and abnormal anatomy. The duty of obstetrician is not to make final and definitive diagnosis for fetal heart defects; only to show four-chamber view and three-vessel view look like normal otherwise it should be evaluated in a comprehensive way named as fetal echocardiography performed by perinatal subspecialty expert. By this approach, major fetal heart defects will not be missed. We hope that this book can serve for this purpose to reader.
Cihat Şen
Preface
Congenital heart defects (CHDs) are among the most prevalent congenital malformations in the mankind and at the same time, their prenatal diagnosis is very often missed in developed and developing countries. Two very important issues concerning the prenatal detection of CHD are prenatal screening and prenatal diagnosis. Screening of CHD belongs to those who make prenatal ultrasound screening of congenital malformations, while a prenatal diagnosis of CHD belongs to experts in fetal echocardiography who can recognize the morphology and the hemodynamics of CHD. In both situations (i.e. screening and diagnosis), one should be informed about basics of the heart embryology in order to better understand anatomy and morphology of the fetal heart. Book in front of you is offering you means to learn how to screen fetal heart to make a distinction between normal and abnormal findings and at the same time, it is giving information on the sophisticated diagnostic approach to fetal CHD in case of positive screening. After the diagnosis of fetal CHD, the counseling is taking place in order to better predict the future of the fetus/infant and entire family. Genetic counseling is very important as well and should be taken into consideration, if indicated. After the diagnosis of fetal CHD, the treatment plan should be made and parents should be asked concerning the preferences of pregnancy termination, prenatal and postnatal treatment. In order to enable the parents to make the best possible choice, one should be aware of the postnatal outcome of severe and hemodynamically significant CHD. The parents should always be informed about the restrains of our counseling and should be given the best information possible in terms of short- and long-term postnatal outcome of the child with severe and hemodynamically significant CHD.
This book is giving many practical pieces of advice with numerous illustrations, which makes it suitable for use in everyday clinical practice. The chapter on fetal arrhythmias, which are not seen very often in everyday life, is making this book even more practical and applicable. We recommend this book for beginners in fetal ultrasound, but it is at the same time very useful for more experienced professionals in fetal echocardiography who will find comprehensive information on how to detect, counsel, and treat patients with CHD detected prenatally using sophisticated and advanced ultrasound techniques.
Milan Stanojevic
Acknowledgments
Finally, we are thankful to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr MS Mani (Group President), Ms Chetna Malhotra Vohra (Associate Director—Content Strategy), Ms Pooja Bhandari (Production Head) and Ms Prerna Bajaj (Development Editor) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for giving a go-ahead at the very beginning and helping us in every way possible to bring out this book.