Basic fetal echocardiography as part of the routine anatomy scan is very useful in showing both normal fetal hearts and abnormal cardiovascular physiology and anatomy. In maternal fetal and pediatric cardiology centers where fetal echo is routinely performed, over 97 % of significant anatomic and physiologic anomalies and arrhythmias can be identified. However, most fetuses with these issues are missed at the routine fetal anatomy scan for a variety of reasons. It is therefore incumbent upon those who are facile with the techniques of fetal echo to teach and promote the use of simple training methods by examples. We highly recommend the use of video clips of the fetal heart to show the anatomic and functional relationships of the veins, atria, ventricles and great arteries.
Alexis C. Gimovsky, Brianne Whitney, Dennis Wood and Stuart Weiner
BACKGROUND: The Myocardial Performance Index (MPI) is a Doppler derived myocardial function tool and can be used to evaluate
systolic and diastolic function in fetuses. The objectives of this study were to investigate the MPI during labor and compare it to values
in non-laboring women.
METHODOLOGY: 40 women with uncomplicated, term, singleton pregnancies were recruited to this prospective observational study at
Thomas Jefferson University Hospital. Controls were a retrospective cohort of women > 34 weeks who underwent third trimester fetal
echocardiography. Fetal left and right sided isovolumic contraction time, isovolumic relaxation time and ejection time were recorded
before, during and after contractions. Right and left sided MPI was then calculated.
RESULTS: Laboring patients and non-laboring patients were comparable for age, race, gravidity and parity. During labor the average left
MPI was 0.63 ± 0.17 and the average right MPI was 0.62 ± 0.20. The coefficient of correlation between MPI and cervical dilation was
0.15 for left MPI Index and 0.14 for right MPI. When comparing non-laboring to laboring women, the average left MPI for non-laboring
women was 0.34 ± 0.04, p = <0.001.
CONCLUSIONS: Myocardial Performance Index is a non-invasive, easily attainable measure of cardiac function that can be obtained
during labor and does not change with cervical dilation. MPI is significantly different between laboring and non-laboring women.
The fetal MPI may help define fetal status in labor.
Katarzyna Leszczyńska, Krzysztof Preis, Maria Respondek-Liberska, Maciej Słodki, Dennis Wood, Stuart Weiner, Ulli Gembruch, Giusseppe Rizzo, Reuven Achiron, Jay D Pruetz, Mark Sklansky, Bettina Cuneo, Birgit Arabin, Isaac Blickstein and
Progress in the fields of fetal cardiology and fetal surgery have been seen not only in singleton pregnancies but also in multiple pregnancies. Proper interpretation of prenatal echocardiography is critical to clinical decision making, family counseling and perinatal management for obstetricians, maternal fetal medicine specialists, neonatologists and pediatric cardiologists. Fetal echocardiography is one of the most challenging and time-consuming prenatal examinations to perform, especially in multiple gestations. Performing just the basic fetal exam in twin gestations may take an hour or more. Thus, it is not practical to perform this exam in all cases of multiple gestations. Therefore our review and recommendations are related to fetal echocardiography in twin gestation.
Maria Respondek-Liberska, Mark Sklansky, Dennis Wood, Maciej Słodki, Stuart Weiner, Bettina Cuneo, James C. Huhta, Ulli Gembruch, Giuseppe Rizzo, Gurleen Sharland, Reuven Achiron and Jay D. Pruetz
The first recommendations and guidelines for physicians training in fetal echocardiography (FE) were created in 1990 and later on up-dated by multiple medical associations and journals in Europe and the United States. This time advanced fetal cardiac ultrasound recommendations focused more on the organizational and logistical aspects of FE, to better define the fetal echo guidelines for practitioners in tertiary centers. Underlined is FE in 3rd trimester, with special attention to the direction of flow across the foramen ovale and ductus arteriosus.
AHA classification of heart defects in prenatal cardiology into seven major groups (from 2014) is presented as well as the Polish classification into four groups (from 2012) related to the urgency of required time to postnatal treatment/intervention based on FE findings in the 3rd trimester of pregnancy.
Current definition of fetal cardiologist in 2015 is also presented.