🫀 How to Start Scanning in Fetal Echocardiography
🎯 STEP 1: Patient Preparation & Position
✔ Patient supine বা slight left lateral
✔ Comfortable position নিশ্চিত করুন
✔ Probe: Curvilinear (3–5 MHz)
👉 Tip: Empty bladder usually যথেষ্ট
🎯 STEP 2: Orientation & Entry Point
✔ প্রথমে fetal lie বুঝুন
✔ Spine locate করুন
✔ তারপর abdomen → thorax এ যান
👉 Always start from fetal abdomen → go upwards
🎯 STEP 3: Determine SITUS (Very Important First Step)
✔ Stomach left side?
✔ Spine posterior?
✔ Heart left chest এ?
👉 Normal: Situs solitus
❗ ভুল situs = ভুল diagnosis
🎯 STEP 4: Get FOUR CHAMBER VIEW
✔ Transverse plane
✔ Heart centered
✔ Check:
- RA / LA size
- RV / LV symmetry
- AV valve offset
- Septum intact
👉 Rule: “4 chamber perfect না হলে সামনে যাবেন না”
🎯 STEP 5: Assess CARDIAC AXIS
✔ Normal ≈ 45° ± 20°
✔ Left deviation বা abnormal rotation দেখুন
🎯 STEP 6: OUTFLOW TRACTS (Most Critical)
🔹 LVOT
✔ LV → Aorta continuity
🔹 RVOT
✔ RV → Pulmonary artery
✔ Crossing pattern confirm করুন
👉 এখানে অনেক major CHD ধরা পড়ে
🎯 STEP 7: THREE VESSEL VIEW (3VT)
✔ PA > Aorta > SVC size
✔ Alignment normal কিনা
👉 Simple but powerful view
🎯 STEP 8: ARCH VIEWS
✔ Aortic arch (candy cane shape)
✔ Ductal arch (hockey stick shape)
✔ Coarctation suspicion দেখুন
🎯 STEP 9: M-MODE (Rhythm Check)
✔ Heart rate (120–160 bpm)
✔ AV relation
✔ Arrhythmia আছে কিনা
🎯 STEP 10: COLOR DOPPLER
✔ AV valves flow
✔ Outflow flow
✔ Septal defect check
👉 Overuse করবেন না—targeted use
🎯 STEP 11: Final Quick Checklist
✔ Situs
✔ 4 chamber
✔ Outflows
✔ 3VT
✔ Arches
✔ Rhythm
👉 সব ঠিক = “Likely normal”
⚡ GOLDEN SCANNING SEQUENCE
👉 Abdomen → Situs → 4 Chamber → Outflow → 3VT → Arch → Rhythm
⚠️ COMMON BEGINNER ERRORS
❌ Direct heart scan (abdomen skip)
❌ Only 4 chamber দেখে stop
❌ Outflow ignore
❌ Wrong orientation
💡 PRO TIPS (High Yield)
✔ Slow scan = better diagnosis
✔ Probe movement smooth রাখুন
✔ সন্দেহ হলে repeat scan
✔ Same protocol every patient
🎯 PRACTICE PLAN
✔ Daily 5–10 normal case
✔ 1–2 detailed study
✔ Images save করুন
🚀 FINAL INSIGHT
👉 Fetal Echo = pattern recognition + discipline
👉 Protocol follow করলেই 80% success
ডা. মোহাম্মদ নিজাম উদ্দিন
Dr. Mohammed Nizam Uddin
MBBS, BCS (Health), MD (Cardiology)
Post Doctoral Training (Cardiac Intervention)
Advanced Fellowship (Fetal Cardiology & Intervention)
ক্লিনিক্যাল অ্যান্ড ইন্টারভেনশনাল কার্ডিওলোজিস্ট
পায়োনিয়ার ফিটাল ইকোকার্ডিওগ্রাফি বিশেষজ্ঞ
Clinical & Interventional Cardiologist
Pioneer Fetal Echocardiography Expert
সহযোগী অধ্যাপক ও সিনিয়র কনসালট্যান্ট, কার্ডিওলজি
Associate Professor & Senior Consultant, Cardiology