ΚΑΡΔΙΑ ΕΜΒΡΥΟΥ
GUIDELINES
Cardiac screening examination of the fetus: guidelines for
performing the ‘basic’ and ‘extended basic’ cardiac scan
PDF 1
Table 2 Common indications for fetal echocardiography
Maternal indications
Family history First-degree relative of proband
Pre-existing metabolic disease Diabetes Phenylketonuria
Maternal infections Parvovirus B19 Rubella Coxsackie
Cardiac teratogen exposure RetinoidsPhenytoin Carbamazepine Lithium carbonate Valproic acid
Maternal antibodies Anti-Ro (SSA) Anti-La (SSB)
Fetal indications
Suspected fetal heart anomaly
Abnormal fetal karyotype
Major extracardiac anomaly
Abnormal nuchal translucency"3.5 mm before 14 weeks’gestation
Fetal cardiac rate or rhythm disturbances Persistent bradycardiaPersistent tachycardia Persistent irregular heart rhythm
AIUM Practice Guideline
for the Performance of
Fetal Echocardiography
aium pdf 2
The American Institute of Ultrasound in Medicine (AIUM) is a multidisciplinary
association dedicated to advancing the safe and effective use of
ultrasound in medicine through professional and public education, research,
development of guidelines, and accreditation. To promote this mission,
the AIUM is pleased to publish in conjunction with the American College of
Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal
Medicine (SMFM) this AIUM Practice Guideline for the Performance of Fetal
Echocardiography. Additionally, this guideline is endorsed by the American
College of Radiology (ACR).
B. Cardiac Imaging Parameters: Basic Approach
The fetal echocardiogram is a detailed evaluation of
cardiac structure and function. This method typically
involves a sequential segmental analysis of 3 basic
areas that include the atria, ventricles, and great
arteries and their connections.11–13 A segmental
analysis includes an assessment of the following
connections and their relationships:
• Atrial arrangement (situs);
• Atrioventricular junction between the atria and
ventricles;
• Ventriculoarterial junction between the ventricle
and arterial outflow tracts.
Each anatomic segment can be further evaluated for
associated anomalies such as cardiac malposition,
atrial isomerism, aortic override, an atrial septal
defect, a ventricular septal defect, myocardial hypertrophy,
abnormal systemic and pulmonary venous
connections, a restricted foramen ovale mechanism,
ventricular disproportion, coarctation, and abnormal
development of mitral or tricuspid valves.
C. Gray Scale Imaging (Recommended)
Key scanning planes can provide useful diagnostic
information about the fetal heart (Figures 1–3).14–19
The following cardiac images should be obtained:
• Four-chamber view;
• Left ventricular outflow tract;
• Right ventricular outflow tract;
• Three-vessel and trachea view;
• Short-axis views (“low” for ventricles and
“high” for outflow tracts);
• Aortic arch;
• Ductal arch;
• Superior vena cava; and
• Inferior vena cava.
D. Doppler Sonography (Optional but
Recommended for Suspected Cardiac
Flow Abnormalities)
Spectral, continuous wave, color, and/or power
Doppler sonography can be used to evaluate the
following structures for potential flow or rhythm
disturbances20–23:
• Pulmonary veins;
• Foramen ovale;
• Atrioventricular valves;
• Atrial and ventricular septa;
• Aortic and pulmonary valves;
• Ductus arteriosus; and
• Aortic arch.
E. M-Mode Echocardiography (Optional but
Recommended for Cardiac Rate or Rhythm
Abnormalities)
M-mode echocardiography displays moving structures
along a thin sampling line over time. The high
temporal resolution makes it useful for the assessment
of ventricular contractility. Cardiac rhythm
disturbances can be characterized by establishing
an atrial rate, ventricular rate, and their relationship
to each other. Alternative approaches, based on
pulsed wave or tissue Doppler sonography, have also
been used for evaluating fetal heart dysrhythmias.24
F. Cardiac Biometry (Optional but Can Be
Considered in the Presence of Structural
Anomalies)
Normal ranges for fetal cardiac measurements have
been published as percentiles and z scores that are
based on gestational age or fetal biometry. Individual
measurements can be determined from M-mode or
2-dimensional images, and they include the following
parameters22,25–31:
• Aortic and pulmonary artery diameters at the
level of the valve annulus;
• Aortic arch and isthmus diameter measurements;
• End-diastolic ventricular dimensions just inferior
to the atrioventricular valve leaflets; and
• Thickness of the ventricular free walls and
interventricular septum just inferior to the
atrioventricular valves.
• Additional measurements may be taken if
warranted, including:
• Systolic dimensions of the ventricles;
• Transverse dimensions of the atria; and
• Diameter of branch pulmonary arteries.
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2 Effective February 5, 2010—AIUM PRACTICE GUIDELINES—Fetal Echocardiography