Ultrasound images of anomalies of the fetal heart

The above fetal echocardiography images show the normal fetal heart. Note the foramen ovale opening to the left atrium. LA= left atrium

RA= right atrium;  LV= Left ventricle; RV= Right ventricle.

There is a ventricular septal defect involving the upper part of the septum. A large atrial septal defect (ASD) is also seen in these ultrasound images.

AVSD is also known as endocardial cushion defect or AV canal defect. It is caused by poor or faulty development of the endocardial cushion. These fetuses usually have other associated cardiac anomalies. The above images reveal large defects in the atrial and ventricular septae with a single large Atrio-ventricular valve replacing the mitral and tricuspid valves. In fact the the ASD is so large, that it appears like a single large atrium. Images courtesy of Dr. Latha Natrajan, Bangalore, India. 

Reference: http://www.centrus.com.br/DiplomaFMF/SeriesFMF/18-23-weeks/chapter-04/heart/heartfmf-complete.html (free article with video clips and images)... rated (by us) as excellent.

Ultrasound video (fetal echo video) of AVSD:  http://www.ultrasoundlink.net/avsd (fetal medicine foundation)

 Sonography of this 36 weeks old fetus revealed a large echogenic mass in close relation to the exterior of the fetal left ventricle, within the pericardial cavity.. A small pericardial effusion is also present. These ultrasound images suggest a solid, non-calcific mass of the pericardium. Possibilities include rhabdomyoma, teratoma and hemangioma. Rhabdomyomas are the commonest pericardial tumours and account for almost 75 % of cardiac masses. Teratomas can be either cystic or solid. Image courtesy of Dr. Prathima Radhakrishnan, Bangalore, India.

1) Pericardial Hemangioma Presenting as Thoracic Mass in utero (abstract)

This is a 4.2 MB video file in GIF format. It might take some time to download. The aorta and the pulmonary trunk are seen mostly arising from the right ventricle. This condition is difficult to distinguish from Fallot's tetralogy and Transposition of the great arteries (TGA). Video courtesy of Dr. Latha Natrajan, Bangalore, India.

http://www.mediamax.com/drjoea/Links/0E0B3BA31B (this is a short download at 45 KB).

References: Fetal echocardiography video of Double outlet right ventricle: http://www.ultrasoundlink.net/double-outlet-right-ventricle-dorv-echo (fetal medicine foundation)

 Sonography of fetal VSD.

These ultrasound and color Doppler images show a VSD in the muscular part of the ventricular septum of the fetal heart. This type of VSD is called a trabecular ventricular septal defect. Flow is seen across the defect in the septum, from left ventricle to the right (color Doppler images). There are 4 types of VSD:

a) perimebranous b) inlet c) trabecular d) outlet. This classification is based on the location of the defect. Images courtesy of Gunjan Puri, MD, India.

See this link for more: Fetal echocardiography (free article and images). Rated excellent..

 This 3rd trimester fetus showed a small Ventricular Septal Defect (VSD) (see arrow heads), near the cardiac apex. Flow across the septum is seen in red hue on Color Doppler  imaging (arrowheads). Fetal echocardiography images of VSD are courtesy of Gunjan Puri, MD, India.

Ultrasound video (fetal echo) of  fetal VSD: www.ultrasoundlink.net/ventricular-septal-defect-VSD-in-fetus (fetal medicine foundation)

The above 3 B-mode ultrasound images show the fetal heart lying partially outside the thoracic cage (case-2) or completely outside the thorax (case-1). I have added a video (ultrasound) clip of case-1 at my blog:

See:http://cochinblogs.blogspot.com/2009/09/another-case-of-ectopia-cordis.html

Case 1 does resemble an umbilical hernia from the ultrasound images on top. However the Color Doppler image of case 1 clinches the diagnosis of ectopia cordis. This was a early 2nd trimester fetus. Case-1 ultrasound images are courtesy of Dr. Dilraj Gandhi, India. This fetus also shows increased Nuchal thickness.Case-2 shows ectopia cordis with heart partially ouside the thoracic cage.

The ultrasound video of this case can be viewed at this link http://cochinblogs.blogspot.com/2009/04/ultrasound-video-of-ectopia-cordis.html.

This ultrasound image was taken by Joe Antony, MD,India.

Reference:http://www.thefetus.net/page.php?id=45 ( you can read more at this link)

Fetal echo video of ectopia cordis: http://www.ultrasoundlink.net/ectopia-cordis-pentalogy-of-cantrell(fetal medicine foundation)

All three above ultrasound images show echogenic foci in the left ventricle of the fetal heart (3 different cases). The foci are seen in relation to the the chordae tendinae and papillary muscles of the mitral valve leaflets . The overwhelming majority of EIF are seen in the left ventricle and are solitary. The echogenicity of these foci is about the same as that of bone.  Echogenic intracardiac foci (EIF) are often seen in Asian fetuses and are usually insignificant. However a small percentage of such fetuses may show associated fetal anomalies and chromosomal anomalies (aneuploidy). You may view a ultrasound video of the EIF in case-1 at:  http://ultrasound-images.blogspot.com/

Reference: http://www.jultrasoundmed.org/cgi/reprint/17/2/127.pdf 

LV= left ventricle RV= right ventricle; LA= left atrium; RA= right atrium. 

This 34 week old fetus shows what is called a relatively milder form of tricuspid dysplasia; see the ultrasound and color Doppler images of the fetal heart above. We can see the normal flow across the tricuspid valves as well as the bicuspid valves ruling serious functional problems with this fetal heart. The 3 vessels view also supports this diagnosis of mild tricuspid dysplasia- the normal size of the pulmonary artery supports this diagnosis. The only positive finding in this case is the marked thickening of the tricuspid valve leaflets.

The video of this case of tricuspid dysplasia can be viewed below:

References:

Tricuspid dysplasia- ultrasound imaging

http://www.centrus.com.br/DiplomaFMF/SeriesFMF/doppler/capitulos-html/chapter_12.htm

http://www.ultrasoundlink.net/tricuspid-regurgitation-tr-fetus-12-weeks-of-pregnancy

This is a good example of hypoplastic left heart. The main ultrasound findings in this case are a small left ventricle and small left atrium. In addition, the mitral valve is hypoplastic, and hence is barely visualised. In addition, note that the Fetal echocardiogram shows a large and dilated right atrium and right ventricle. The left ventricle is barely visualised and is seen as a small remnant to the extreme left of the fatal heart. The ultrasound video and the ultrasound images above, further confirm that the Fetal ascending aorta and the Fetal aortic valve are small and atretic. Thus, these ultrasound images show a classic picture of hypoplasia of the Fetal left heart, also known as hypoplastic left heart syndrome.

References:

http://www.sonoworld.com/fetus/page.aspx?id=886

Also visit: http://www.ultrasoundlink.net/hypoplastic-left-heart-syndrome-echo(for a great teaching video clip of hypoplastic left heart syndrome from an authority in fetal echocardiography).