Fetal echocardiography

The morphological description of the various cardiac segments and their connections represents the only effective method in recognizing the various congenital heart diseases.

Describing the central connections of the heart, from the venous to the arterial pole, through the various cavities is the only logical and universally accepted way of approaching congenital heart disease.

The approach to the evaluation of cardiac anatomy makes use of various scans that aim at the complete verification of the cardiac anatomy and the great vessels. These scans are mandatory by the SIEOG (Italian Society of Obstetric-Gynecological Ultrasound) during the morphological examination of the fetus.

In case a complete evaluation of the anatomy of the heart and the great vessels is required, fetal echocardiography is performed, a second level examination that involves a direct sequential analysis.

The examination is preferably performed between the 20th and 25th week of gestation.

Congenital heart diseases by scanning are:

4 chambers and malformations:

1. – Atrial anomalies: single atrium, A-V insufficiency atriomegaly, congenital mega-atrium interatrial defect (ostium primum).
2. – septal defects: interventricular defect, complete A-V canal
3. – single A-V input.: tricuspid atresia, hypoplastic left heart, single-entry single ventricle, hypoplastic right heart
4. – double entry into single ventricle: single ventricle with double entry
5. – ventricular disproportion: aortic coarctation, mitral stenosis, pulmonary atresia
6. – reduced unilateral contractility: critical aortic stenosis, critical stenosis / pulmonary atresia
7. – reduced bilateral contractility: cardiomyopathy
8. – bilateral myocardial hypertrophy: cardiomyopathy

Scan of the three vessels:

1. caval anomalies: left superior cava persistence, right superior cava agenesis
2. arch anomalies: aortic coarctation, interruption of the arch, right aortic arch
3. pulmonary anomalies: pulmonary atresia
4. anomalies of the thymus: aplasia, hypoplasia

Left outflow scan:

1. septal anomalies: peri membranous DIV in outlet, DIV in malalignment
2. anomalies of the aorta: critical aortic stenosis, aortic hypoplasia truncus arteriosus
3. junction anomalies: transposition of the great vessels, double outlet right ventricle.